자료유형  

 학위논문

Control Number  

0016931372

International Standard Book Number  

9798379703080

Dewey Decimal Classification Number  

614.4

Main Entry-Personal Name  

Smith, Richard D.

Publication, Distribution, etc. (Imprint  

[S.l.] : University of Maryland, Baltimore., 2023

Publication, Distribution, etc. (Imprint  

Ann Arbor : ProQuest Dissertations & Theses, 2023

Physical Description  

1 online resource(154 p.)

General Note  

Source: Dissertations Abstracts International, Volume: 84-12, Section: B.

General Note  

Advisor: Ernst, Robert K.;Johnson, J. Kristie.

Dissertation Note  

Thesis (Ph.D.)--University of Maryland, Baltimore, 2023.

Restrictions on Access Note  

This item must not be sold to any third party vendors.

Summary, Etc.  

요약To optimally manage bloodstream infections, quick and appropriate antimicrobial treatment is critical. Rapid diagnostic testing (RDT) can help guide antimicrobial therapy in a timely and reliable fashion. Use of RDT in clinical microbiology is associated with improved patient outcomes including decreased mortality, morbidity, time of hospital stay, and patient costs. The ideal RDT is accurate, rapid, identifies antimicrobial resistance, is easy to use, and low cost. For septic patients, time to appropriate antimicrobial therapy is inversely related to the patient's survival; therefore, fast, and accurate RDT is especially important. Several different types of RDT assays exist, including polymerase chain reaction, nanoparticle probe technology, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). MALDI-TOF MS is a mainstay diagnostic technology that has revolutionized the world of clinical microbiology. MALDI-TOF MS methods are high-throughput and have extensive pathogen panels. Microorganisms can be identified by MALDI-TOF MS once growth in culture is visible, thereby providing a decrease in both pathogen identification and time to effective antimicrobial therapy. Limitations of current MALDI-TOF MS diagnostics include limited ability in the identification of antimicrobial resistance and time to identification of organism, typically requiring 24-48 hours of additional ex vivo culture after positive blood culture. Recently, novel MALDI-TOF MS based technologies have been developed to identify pathogens direct from positive blood culture bottles, eliminating the need for further culture; however, novel technologies need to be evaluated and compared to current methods to provide valuable insight about the use of these diagnostics in clinical microbiology laboratory settings. This study addresses current limitations of MALDI-TOF MS diagnostics; specifically, the inability to identify antimicrobial resistance and limited ability identifying pathogens directly from biological specimen. In Specific Aim 1, a novel lipid-based extraction for MALDI-TOF MS termed Fast Lipid Analysis Technique (FLAT) was evaluated for its clinical utility in identifying colistin resistant Enterobacter species and Klebsiella aerogenes utilizing MALDITOF MS. For Specific Aim 2, positive patient blood cultures were prospectively collected from the University of Maryland Medical Center (UMMC) clinical microbiology laboratory to evaluate and compare the FDA-approved, MALDI-TOF MS assay Bruker MBT Sepsityper® to FLAT MS and other FDA-approved, molecular-based, direct-from-blood culture RDTs. Finally, Specific Aim 3 compared the use of FLAT for direct-from-blood culture identification to the other previously compared RDTs using the novel Benefit-risk Evaluation for Diagnostics Framework (BED-FRAME).

Subject Added Entry-Topical Term  

Epidemiology.

Subject Added Entry-Topical Term  

Microbiology.

Subject Added Entry-Topical Term  

Pathology.

Index Term-Uncontrolled  

Blood culture

Index Term-Uncontrolled  

Clinical microbiology

Index Term-Uncontrolled  

Diagnostics

Index Term-Uncontrolled  

Antimicrobial treatment

Index Term-Uncontrolled  

Bloodstream infections

Added Entry-Corporate Name  

University of Maryland, Baltimore Epidemiology and Preventive Medicine

Host Item Entry  

Dissertations Abstracts International. 84-12B.

Host Item Entry  

Dissertation Abstract International

Electronic Location and Access  

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Control Number  

joongbu:643361