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    • 专利摘要:
    The invention relates to a method for determining the reaction of at least one bacterium of interest to its exposure to an antibiotic implementing a Raman spectroscopy analysis and comprising the following steps: There is a biological sample that may contain said bacteria of interest, at least two fractions of said sample each comprising one or more living bacteria of interest are prepared. At least one bacterium of living interest is captured in each fraction by means of a binding partner, exposes at least one of the fractions to at least one concentration of at least one given antibiotic, the other of the fractions being the control fraction, The bacterium (s) of interest contained in the fractions to an incident light and the resultant light obtained by Raman scattering by the bacterium (s) of interest by Raman spectroscopy to obtain as many Raman spectra as of bacteria, said spectra are processed to obtain a signature of the reaction of the or each bacterium (s) of interest to the exposure of said antibiotic and the control, the signature thus obtained by bacterium of interest is compared to a reference base defined under the same conditions as above, for different bacteria and at least said antibiotic, and a clinical profile of sensitivity of said bacterium of interest to said antibiotic is defined.
    公开号:FR3044415A1
    申请号:FR1561446
    申请日:2015-11-27
    公开日:2017-06-02
    发明作者:Armelle Novelli-Rousseau；Isabelle Espagnon；Quentin Josso；Alice Douet；Frederic Mallard；Olivier Gal
    申请人:Biomerieux SA；Commissariat a lEnergie Atomique CEA；Commissariat a lEnergie Atomique et aux Energies Alternatives CEA；
    IPC主号:
    专利说明:

    The invention falls within the scope of the analysis of the sensitivity phenotype of microorganisms to antibiotics. It relates to the determination of the reaction of at least one microorganism of interest to its exposure to an antibiotic using a Raman spectroscopy analysis and its applications.
    The term "microorganism" covers any microorganism that may react to its exposure to an antibiotic, such as bacteria or yeasts. Although the invention is more specifically described below with reference to bacteria, it is understood that it is not limited thereto.
    This determination is of major interest in the microbiological diagnosis in the fields of health, agri-food, environment, it can be just as important in pharmacology, in the screening of new molecules, especially antibiotics, or in search of cytotoxic compounds present in food products, for example milk. This selection of applications is not exhaustive, and in general, the invention can find an application in any field as soon as the question is posed of the reaction of cells to an exposure to a chemical or biological compound. The Raman effect is a phenomenon of light diffusion that applies to the vast majority of molecules. Its observation in spectroscopy makes it possible to characterize a molecule, a microorganism, a medium, it is of a simple implementation, it is fast and economic, and has the substantial advantage in biology of not being strongly disturbed by water. and do not require marking or contrast agent.
    Thus according to the document AIM Athamneh et al. (2014) Antimicrob Agents Chemother 58: 1302-1314, the authors used Raman spectroscopy to characterize the sensitivity of E. coli cultures to 15 known antibiotics representing 5 families of antibiotics, in order to constitute a baseline. For this purpose, the method described comprises the following steps, production of an E. coli culture, exposure of a sample of this culture to antibiotics in a concentration of three times the minimum inhibitory concentration (MIC), maintenance of said cells in contact with the antibiotic for at least 30 minutes, harvesting and washing the bacterial cells, taking a cell suspension and treatment for analysis of the cell layers by Raman spectroscopy. The result of the analysis is derived from the average of a multiplicity of spectra obtained for each sample comprising a multitude of cells and integrated into the reference base. Once constituted, this reference base can be exploited to assign an unknown antibiotic to one of said families, depending on the sensitivity of an E. coli culture to that antibiotic. The classification results thus obtained make it possible to obtain elements as to the class of the unknown molecule, which can be useful for pharmacological research. The results obtained, however, do not provide information related to the susceptibility phenotype of the bacteria studied nor information that is conducive to clinical use.
    The document WO2013 / 093913A1 describes a method for identifying a bacterium in a biological fluid using, in particular, Raman spectroscopy. A sample of a bacterial culture of said biological fluid is subjected to incident light and the resultant light obtained by diffusion is analyzed by Raman spectroscopy. The read signal is then interpreted by means of a reference database listing the spectral signature of different microorganisms defined under the same conditions. This method may further comprise a step of exposing said bacteria to an antibiotic, the signal then read being an effect of said antibiotic on these bacteria. The effect of the antibiotic measured is exerted especially on the viability of bacterial cells or the development of the culture. The disadvantage of this method lies in its use of a culture step which not only lengthens the obtaining of a response, but which, in addition, requires mastering an additional step necessary to obtain the expected response.
    While the use of Raman spectroscopy makes it possible to reduce the determination of the clinical profile of susceptibility to an antibiotic of bacteria of interest, the fact remains that, according to this prior art, it is applied to a bacterial culture of which obtaining in a time of about 18 to 24 hours, does not allow access to a rapid determination method. In diagnosis, this constitutes a major obstacle to effective management of patients.
    According to the document U. Münchberg et al. (2014) Anal Bioanal Chem 406: 3041-3050, the authors raise the problem of the rapid introduction of appropriate antibiotic treatment in a patient, as well as the difficulties encountered by techniques using a cell culture when the patient has already received antibiotic treatment. The authors then overcome the culture step and apply Raman spectroscopy to individual bacteria. This work therefore addresses the problem of identifying bacteria that have previously been exposed to an antibiotic, a potential source of a misdiagnosis. To solve this problem, the authors constitute a reference base including the results of the Raman analysis performed on individual cells not exposed to an antibiotic and on cells that have been exposed to an antibiotic, in different concentrations below the minimum concentration. inhibitor (MIC). The conclusion of this study is a lack of major difficulty in identifying bacteria under these conditions. The authors did not notice any significant effect of antibiotics on bacterial spectra and conclude that possible changes are observed in areas of high variability and therefore unusable.
    None of these solutions makes it possible to envisage a reliable method for determining the clinical profile of susceptibility to an antibiotic of a bacterium of interest and in particular of its resistance or sensitivity to an antibiotic, in a short time of the order of a few hours that would allow a diagnosis in the day. This deficiency is responsible for ineffective antibiotic therapy, risk of worsening the patient's infection and difficulty in making an accurate diagnosis when the patient has already been treated. This lack is all the more felt at the time of emergence and the spread of multi-resistant bacteria to antibiotics. The invention provides a response to this need with a method for determining the reaction of a bacterial strain of interest to its exposure to an antibiotic, requiring no culture, the result of which is accessible in about 2 hours is therefore very fast by compared to state-of-the-art methods (36h-72h), which is also reliable. The invention relates to a method for determining the reaction of at least one microorganism of interest, such as a bacterium of interest, to its exposure to an antibiotic implementing a Raman spectroscopy analysis and comprising the following steps:
    There is a biological sample that may contain said bacteria of interest,
    At least two fractions of said sample each comprising one or more living bacteria of interest are prepared,
    At least one bacterium of living interest is captured in each fraction using a binding partner,
    At least one of the fractions is exposed to at least one concentration of at least one given antibiotic, the other of which is the control fraction,
    The bacterium (s) of interest contained in the fractions are subjected to incident light and the resultant light obtained by Raman diffusion by the bacterium (s) of interest by Raman spectroscopy is analyzed to obtain as many Raman spectra as bacteria,
    The material constituting the support in the fractions is subjected to an incident light and the resultant light obtained by Raman diffusion of said support by Raman spectroscopy is analyzed to obtain some Raman spectra of this support,
    Said spectra are processed to obtain a signature of the reaction of the or each bacterium (s) of interest to the exposure of said antibiotic and the control,
    The signature thus obtained by bacterium of interest is compared to a reference base defined under the same conditions as above, for different bacteria and at least said antibiotic, and
    A clinical profile of sensitivity of said bacterium of interest to said antibiotic is defined. The advantage of the process of the invention compared to the state of the art cited above is that it makes it possible to obtain a relevant signal correlated with the chemical modifications of the microorganisms in response to their exposure to the test compound. using Raman spectrometry, for individual cells. Not only does it dispense with the cell culture step, but it also provides information per cell analyzed. Unlike known methods, the information is not obtained by averaging the analysis results or by obtaining a physically averaged measurement. It is the expression of a result per cell, which leads to a more relevant information in that it makes it possible to detect a variability, and which could be significantly different from that resulting from an average of results which masks any heterogeneity. . Of course, depending on the applications considered, the information can be obtained from the result of several individual cells.
    According to the invention, there is provided a method for determining the reaction of a bacterium to its exposure to an antibiotic, by Raman spectroscopy, which is suitable for all the applications envisaged above. It can actually be used to characterize the clinical sensitivity profile of a bacterium of interest to an antibiotic, in a biological sample, but it can also be arranged for the screening of antibiotic molecules. Since it does not use a culture step, it is also suitable for non-culturable cell analysis.
    Before going into more detail, the description of the method of the invention, certain terms used are hereinafter defined.
    By biological sample is meant a tissue, a fluid, as well as components of said tissue and fluid. Depending on the scope of the process, and as non-exhaustive examples, the sample may be of human or animal origin such as blood, urine, saliva, breast milk; it can be of plant origin, be a food extract, an extract of the soil ...
    By reaction of a microorganism of interest such as a bacterium of interest to its exposure to an antibiotic (ATB), it is understood any modification, for example metabolic, which can be detected by Raman spectroscopy compared to the same non-bacterium. exposed to an antibiotic.
    The minimum inhibitory concentration (MIC) of an antibiotic for a given bacterium, expressed in μg / ml, is the lowest concentration of said antibiotic of a range of dilutions capable of stopping bacterial growth.
    A clinical breakpoint is a given concentration of a defined antibiotic for a species, determined by the European Committee for Antimicrobial Susceptibility Testing (EUCAST) on the basis of microbiological criteria and pharmacokinetic and pharmacodynamic data. Conventionally, two different breakpoints, called threshold values, are defined and thus determine a range of concentrations. When the MIC of a strain tested is below this range, the strain tested is qualified as sensitive, that is to say that it is capable of being inhibited in vivo thus implying a high probability of therapeutic success. ; if it is in this range, the bacterium is said intermediate, and if it is beyond this interval, the bacterium is said to be resistant, that is to say that it supports antibiotic concentrations higher than those acceptable in vivo and for which there is a high probability of therapeutic failure.
    By signature of the reaction of a microorganism of interest to its exposure to a chemical compound is meant any variation, for example metabolic or constitutional, expressed by said microorganism specifically in response to its contact with said compound and which can be detected by spectrometry Raman. In order to more easily highlight these variations, it is also possible to call the signature the result of one or more Raman data processing steps resulting in a signal used to carry out the test. For example, one may choose to subtract an initial state or a condition where the bacteria of interest have not been exposed to the test compound to the spectra acquired on exposed bacteria.
    Preferred variants of a method of the invention are hereinafter presented, they must be considered alone or in combination. They are more suitable for diagnostic applications, and specifically for determining the clinical sensitivity profile of a bacterium to an antibiotic in a biological sample, but as said above the method of the invention is not restricted to such applications .
    The determination of the clinical sensitivity profile of a bacterium to an antibiotic consists first of all in identifying the susceptibility phenotype of a bacterium to an antibiotic. Thus, more than two fractions of said sample are preferably prepared and at least two fractions are exposed to increasing concentrations, respectively, of the antibiotic. According to variants of the process of the invention, at least three fractions of said sample, or even four or five or more, are exposed to increasing concentrations, respectively, of the antibiotic.
    Advantageously, the concentrations of said antibiotic are chosen within a range of values reflecting conventional concentrations of in vitro tests, thus allowing a comparison with the current reference data, for example with the microdilution tests. According to a preferred variant, the concentrations of the antibiotic to which the fraction or fractions are respectively exposed are in a range of values including at least one of the values chosen from among the typical MICs and the threshold values of clinical breakpoints for the couple. species / antibiotic tested, or concentration panels used in the reference methods. In a diagnostic application of the process of the invention, these concentrations are therefore specifically chosen as a function of the bacterium / antibiotic pair considered as an example for the pair f.co///Gentamicine for which the typical CM), or the cut -off epidemiological case of the species, is 2pg / mL and both clinical breakpoints are 2 and 4 pg / mL, they can be within a range of values including at least one of the values selected from 1, 2, 4 and 8 and 16 μg / ml, preferably two or even three or four of these values or even these five values.
    The method of the invention comprises a step of capturing a bacterium of interest by means of a binding partner. A binding partner according to the invention specifically or specifically recognizes a bacterium of interest for the capture of it-cr for analysis. During its interaction with the bacterium, the binding partner may be present in the free state in the medium or may have previously been immobilized on a support. If the attachment of the bacterium on the binding partner takes place in the medium, an immobilization of said partner on the support can be carried out subsequently. By immobilization on a support is meant a direct or indirect immobilization of said link partner on said support, by any means well known to those skilled in the art. A binding partner according to the invention may be of a biological and / or chemical nature. Thus, by way of example, in the case of a nonspecific or generic capture of cells, it may consist of a chemical compound or carry chemical functions that will interact (have) with the cells. Polymers of the chitosan, poly-L-lysine, polyethylenimine and polyaniline type are illustrations thereof. It may consist of a biological molecule such as selected from proteins, antibodies, antigens, aptamers, phages, phage proteins; this will usually be a specific capture of the cells. In an advantageous variant of the invention, the binding partner is immobilized on the support and then the bacterium captured by said immobilized binding partner. The capture step may be performed on fractions of one or more bacteria exposed to an antibiotic and control, after concentration of said fractions. For example, these fractions are concentrated by centrifugation and then the pellets which are subjected to the capture step are recovered. Advantageously, the capture is directly carried out in the biological sample without a separate pellet concentration step.
    After the capture step, the captured bacteria are identified and sorted. This step is carried out for example by imaging or spectrophotometry. Uncaptured bacteria can then be eliminated.
    The preferred conditions of exposure of the bacteria to the antibiotic are hereinafter mentioned: The antibiotic is in a physiological medium allowing at least to maintain the living bacterium (s) of interest. Exposure to the antibiotic is carried out at a culture temperature of the strains considered, from about 18 ° C to about 40 ° C, typically between 28 ° C and 37 ° C for strains of clinical interest. Exposure to the antibiotic is carried out during a so-called incubation time much shorter than the time required in the reference methods. According to the invention, the incubation time is advantageously at least 10 minutes and at most 4 hours. Obtaining a signature for each fraction exposed to the antibiotic will be illustrated in the examples.
    In general, several methods can be used to process the data obtained to arrive at the result. In order for this to be as relevant as possible, a complete method of processing the spectra at the individual level is preferably performed. It is divided into two major stages, a preprocessing step that consists in processing the spectra to maximize the extraction of a signal of interest and a classification step that allows the actual test of interest to be performed and lead to the result. interest. The preprocessing step comprises at least one, preferably two, and more preferably all of the operations mentioned below:
    Suppression of saturated spectra
    The suppression of saturated spectra is the first step of pretreatment of the spectra. It is carried out from the raw spectra obtained. The spectra for which more than 20% of the channels of the region of interest have an intensity greater than 99% of the maximum intensity are considered saturated.
    Suppression of cosmic rays
    The so-called "cosmic" rays are charged particles of high energy, of solar origin, galactic or extragalactic, which constantly bombard the detector CCD (Charge-Coupled Device). They cause very fine signal peaks that can appear randomly in the spectra. A search for peaks is first performed from the calculation of the second derivative of the raw spectrum. A comparison of this second derivative and the second derivative of the smoothed rough spectrum then makes it possible to identify the very fine peaks for which the smoothing has significantly reduced the height of the peak, that is to say the cosmic rays. The peaks associated with cosmic rays are replaced by a line. realignment
    There were slight offsets between series of spectra taken at different dates. This offset is a constant across the spectrum. It is better to correct it.
    The method consists of realigning all the spectra with respect to a "reference" constituted by the positions of the 2 peaks 1001 cm -1 and 1126 cm -1. The position of the peaks of the spectra to be realigned is determined from a peak adjustment by a model composed of a Gaussian on an affine background.
    Spectra on individual bacteria generally do not allow realignment by spectrum (too noisy spectra). The realignment is therefore preferably carried out from the average spectra of the bacteria (after removal of the background by the SNIP algorithm). A comparison between the position of 2 peaks in the average net spectrum to be realigned and the reference values of these same 2 peaks makes it possible to measure the offset. The correction found from the bacterial spectra is applied to the environmental spectra of the same date acquired on the material constituting the support.
    Extraction of the specific bacterial signal
    The background is subtracted in two stages. A first base, consisting of a medium spectrum of the material constituting the support, is adjusted for example between 450 and 650 cm -1 to the bacterium spectrum in the case of a glass support because it is a region where there is no that the spectral contribution of glass. This adjustment is made with the constraint of staying under the bacterium spectrum in this region. The second step is to subtract a background by the SNIP algorithm.
    Suppression of deviants
    An automatic suppression module for deviant spectra has been developed. The spectra used in deviant search are the normalized net spectra used in the rest of the analysis. The search for deviants is applied to a group of spectra corresponding to a strain, a given antibiotic concentration and a given date. The method is based on the calculation of the Euclidean distance between each spectrum and the average spectrum of a group of spectra. This suppression of the deviants is carried out twice consecutively. The first round removes the very aberrant spectra that have a significant effect on the average spectrum. Region of interest and signal standardization
    The choice of the region of interest is important because it is on this region that the spectra will be compared with each other. The spectra are measured between 400 and 3080 cm "1 of energy shift, the selected region of interest is [650-1750] cm" 1 and / or [2800-30501cm "1. It is essential to standardize the net signals in order to The normalization interval used is [650-1750] cm "1 or [2800-3050] cm" 1. The net signal is divided by the value of the average of the net signal in this interval. It is useful, in an advantageous mode, to subtract a reference state of the bacteria from all the spectra of individual bacteria acquired The reference state used is that consisting of spectra derived from S0. to overcome variations in growth conditions, variations in interface I (see Figure 2) and to extract a signal called signature related to exposure to varying antibiotic agent concentrations.
    As indicated above, the method finds a strong interest in its application to the determination of the clinical phenotypic profile of a bacterium of interest and in particular to determine its sensitivity or its resistance to an antibiotic, and advantageously determine the MIC of said bacterium said antibiotic .
    In this indication and to obtain a relevant result, it will be preferred that each fraction comprise at least 2, preferably at least 5, bacteria of interest to obtain at least 2, preferably at least 5, signals.
    According to a variant of the invention, the bacteria compared are substantially at the same stage of growth.
    In general, a method of the invention can be implemented in a system comprising the following elements:
    A spectrometer allowing the Raman analysis of the sample:
    The Raman spectrometer used is conventionally called a confocal Raman microspectrometer in the state of the art in that it consists of an analysis stage capable of producing a spectrum from the light resulting from the Raman scattering after excitation by a laser, the Raman spectrometer, this analysis stage being coupled to a confocal microscopy stage making it possible to measure a Raman spectrum using a microscope objective and to limit the volume analyzed to a spatially restricted volume, the confocal volume. The microscopy stage of the microspectrometer can also, in a conventional manner, enable the acquisition of images by a camera present in the device or, more simply, by direct observation via eyepieces using a light source integrated or not microspectrometer;
    A device for conditioning microorganisms for spectral analysis; and
    A computer to control the microspectrometer, the storage of collected data and the analysis of these data using a dedicated software implementing the methods below.
    A microorganism conditioning device as mentioned above, optionally coupled to a spectrometer and a computer for carrying out the method of the invention is also an object of the invention.
    A system as discussed above, allowing the implementation of a method of the invention is illustrated in Figure 1 and its implementation is carried out in the following examples. They are described in more detail below:
    The system includes a Raman microspectrometer for confocal analysis of light scattered by microorganism-sized objects (0.5-100 μm), for example a HORIBA brand Aramis spectrometer equipped with a lXx type ZEISS microscope objective. Plan-Neofluar reference 44 080. This microspectrometer is equipped with manual (ocular) or digital (CCD camera, eg IDS brand model peye UI-1240ML) viewing means for the observation of samples in measurement position. Raman measurement parameters are selected appropriately for the object being studied. In the examples which follow, the confocal volume has been adapted to be close to the size of a bacterium (typically a 300 μm confocal hole on the ARAMIS model used) in order to limit the spectral contributions not sought.
    The system also comprises a packaging device, which is an object of the invention, a preferred embodiment D of which is illustrated in FIG. 2. This device comprises: a part P comprising recesses corresponding to a set of chambers (of Ci to CN), N being equal to at least 2, said chambers being optionally optically isolatable fluidically, an optional set of ports Pi to P2n allowing the connection of the fluidic chambers to a liquid management system, a functionalized optical interface I or non-functionalized and compatible with spectral measurement on microorganisms; and an optional part J, assuring the assembly between the parts I and P.
    According to a simplified variant of a packaging device of the invention, it may be a standard microscope slide I (25 mm × 75 mm × 1 mm, for example of the reference 631-1551 from VWR). constituting the piece P, two double-sided adhesives serving as fluidic chamber (for example of the reference AB-0577 from Thermo Scientific commonly called "Gene Frame") constituting the joint J and a cover plate object (for example from the reference 0107052 from Marienfeld) constituting the interface I. The interface I can be functionalized by a so-called "generic" capture chemistry which will be based on properties generally encountered in the microorganisms in solution or by a so-called "specific" capture chemistry. And based on particular properties of a desired species. For example, "generic" capture chemistry can be materialized by the absorption on the coverslip of polycationic molecules (such as polyethylenimine, poly-L-lysine or chitosan, etc.) and the specific capture chemistry can be materialized by the adsorption or coupling of biological molecules such as proteins, antibodies, antigens, aptamers, phage or phage proteins, on the glass surface to allow the capture of a microorganism of interest .
    The conditioning device ensures the physicochemical conditions (temperatures, gas, etc.) enabling the microorganisms of interest to present a metabolic activity.
    Variations of this device D are of course possible and are within the scope of the present invention.
    In a preferred implementation, the following steps are carried out: a solution containing the microorganisms of interest is introduced into the chambers Ci to CN, using the respective fluidic connection ports.
    Pi to Pn, a so-called latency time is respected to cause the microorganisms of interest to bind to the surface I by interaction with the functionalization, introducing, respectively, a growing series of concentrations of the test chemical compound (C2 to CN) in liquid solution and a predetermined amount of physiological medium in each fluid chamber Ci to CN, there is observed a so-called incubation time during which the microorganisms of each chamber are exposed to the chemical compound, with the exception of those of the chamber Ci (control), the identification and sorting of the microorganisms captured on the surface I is carried out, Raman spectral measurements are carried out on the microorganisms isolated in the preceding step until a set of Si to SN spectra is obtained. acquired spectra for the microorganisms of each of the fluid chambers Ci to CN, then a direct analysis of the acquired spectra is carried out, by comparison of the evolution of the pectres of Ci to CN to a previously constituted database, or by the search of a spectral signature by determining the set of spectra S, having a significant evolution, the result of the analysis is constituted by the concentration Q, the comparison of C, at a reference threshold or the expression of the evolution of certain characteristics of the spectra S, as a function of the concentration; it makes it possible to qualify the phenotypic behavior of the microorganisms analyzed with respect to the test compound.
    As indicated above and according to the objective sought for the measurement, several adaptations can be made (number of concentrations tested, incubation time, etc.), the general principle remaining the same.
    The details and advantages of the invention will emerge from the examples below, in support of the following figures according to which:
    Figure 1 shows the block diagram of the complete assembly of a system for implementing the method of the invention incorporating a device of the invention as illustrated in Figure 2.
    FIG. 2 represents the schematic diagram of the microorganism conditioning device belonging to the system illustrated in FIG.
    Figure 3 illustrates a placement of the samples on a glass slide of the conditioning device illustrated in Figure 2.
    FIG. 4 represents an expression of the reaction of the reference Escherichia coli strain ATCC 25922, called "EC10", with gentamicin, obtained according to the process of the invention.
    FIG. 5 represents an expression of the reaction of the reference Escherichia coli strain ATCC 35421, called "EC21", with gentamicin, obtained according to the process of the invention, for N = 5.
    Figure 6 shows the confounding matrix obtained for the sensitive strain of Escherichia coli ATCC 25922, referred to as "EC10", in the presence of amoxicillin (MIC = 6 μg / mL) for N = 11.
    Figure 7 shows the confounding matrix obtained for the sensitive strain of Escherichia coli ATCC reference 35421, referred to as "EC21", in the presence of amoxicillin for N = 11.
    Figure 8 shows the confounding matrix obtained for the sensitive strain of Escherichia coli ATCC reference number 35421, called "EC21", in the presence of amoxicillin tested with a classifier trained with bacteria exposed to gentamicin for N = 11.
    Figure 9 illustrates the signatures obtained for gentamicin concentrations of 0 μg / mL, 2 μg / mL and 8 μg / mL.
    Figure 10 shows a simplified diagram of the principle proposed in Example 4.
    Figure 11 shows an expression of the reaction of a bacterial strain exposed to different concentrations of ciprofloxacin, obtained according to the method of the invention.
    Example 1 Application of the method of the invention to the determination of the sensitivity phenotype of the reference Escherichia coli strain ATCC 25922 called "EC10" to gentamicin
    The selected packaging device consists of two fluid chambers and two antibiotic concentrations are tested: c0: "Without antibiotic" and Ci: "Resistance test".
    Let Ci be the concentration of gentamicin: Ci = 8 μg / mL, which corresponds to the doubling of the concentration 4 μg / mL which corresponds to the clinical breakpoint as defined by EUCAST. The objective of this test is to determine if the bacterium is considered resistant within the meaning of the definitions proposed by EUCAST.
    A solution containing the bacteria to be tested is used as a test sample. This solution is obtained by suspending 5.107CFU / mL to represent a concentration potentially encountered in a clinical sample, for example a urine sample. This solution of bacteria is brought into contact with the interface I of the device functionalized by the adsorption of polyethyleneimine (PEI) (generic capture). After a capture time of 10 minutes allowing the bacteria to come into contact with the functionalization, the interface I is washed with a water solution, this optional step to eliminate the surplus of uncaptured bacteria still in solution. The physiological medium used in this example consists of a poorly enriched mixture of TSB-T Trypcase Soy Broth broth (for example of bioMérieux reference 42100) and 10x PBS (for example obtained from PBS tablets of reference A9162, 0100 brand AppliChem) in a 1: 9 ratio. After dividing into two fractions of this physiological medium, an amount of gentamicin (for example, reference G1397-10ML from Sigma-Aldricht) is added to each of these fractions, making it possible to obtain a different concentration of gentamicin c0 or ci. The solutions of concentrations c0 and Ci thus produced are respectively introduced into the chambers C0 or Ci. The bacteria captured directly from the sample on the surface I are thus exposed, in a suitable medium, to a different concentration of antibiotic according to the room in which they are present.
    The device is then heated to reach a temperature of 37 ° C for two hours and then placed in measurement position on the microspectrometer. The identification of the captured bacteria is performed by an automatic procedure based on image analysis, by a conventional particle detection procedure, acquired by means of the microspectrometer camera and a suitable light source. This identification makes it possible to automatically acquire a series of Raman spectra (S0 and Si, respectively) acquired on individual bacteria present in each chamber C0 and Ci. The number of spectra to be acquired to constitute a data set depends on the level of requirement on the performance of the tests to be performed.
    As said before, several methods can be used to process the data obtained to arrive at the result. In the present example, a complete method of processing spectra at the individual level is used comprising a preprocessing step comprising all the phases described above to maximize the extraction of a signal of interest and the classification.
    In this example, we use a set of at least 2N spectra extracted from the total set M of the acquired spectra: N spectra from S0 and N spectra from Si. These spectra are drawn without any of the M available spectra. Each of the N spectra derived from Si and the N spectra from S0 is subtracted from the average of the N spectra derived from S0, these two batches of spectra constituting a "control test sample" and a "resistance test sample".
    For classification purposes, a reference database obtained from similar experiments made previously at different dates and from different cultures is used in the present example to result in a classifier obtained using a Vector Machine. Support (SVM) with radial core. This classifier is trained to recognize two classes, one "no antibiotic effect" from spectra from conditions without antibiotic and the other "antibiotic effect" from spectra previously acquired under conditions where the concentration is greater than the MIC of the strain (s) used in the reference database. For each sample of tests consisting of N difference spectra, these difference spectra are tested individually against the classifier and the group of N spectra is assigned the majority class among the elements of the groups. This majority allocation is based on the good correlation of the results obtained with the reference methods but can be modified to take into account certain other parameters of the tests. For example, a threshold vote different from the majority where, as soon as the number of bacteria having no effect exceeds 30%, then a "no antibiotic effect" result is conservatively attributed. This threshold can also be adjusted to take into account the incubation time: for example, if the time of exposure to antibiotics is significantly reduced, or if the microorganism under test has a slower typical doubling time, take into account a lower threshold to assign an "antibiotic effect" result to this group of spectra. Finally, we could also adopt a more nuanced system where each bacterium is considered in a totally individual way. This latter embodiment may be advantageous if the method of the present invention is used for research purposes.
    In order to illustrate the performances thus obtained, the average score obtained for all the results that would be obtained with a combination of 5 spectra per concentration (N = 5) out of a total set of total spectra acquired 294 spectra (M = 294) is presented. in Figure 4. This matrix has in column the states "No effect ATB" and "Effect ATB" and online the two antibiotic concentrations tested. The score indicates the percentage of test samples that are assigned to a given class by the classifier described above. Thus, 99% of the N = 5 bacteria samples in the "control test sample" are classified as "No Antibiotic Effect" and 97.1% of the "Sensitivity Test Samples" are bacteria exposed to the test concentration are classified as "ATB effect". The strain can therefore be described as sensitive according to the invention with great confidence on the basis of only a few analyzes of individual bacteria. The result is in accordance with the reference methods (bioMérieux or vitek bioMérieux test) which give a MIC = lpg / mL, which confirms that the bacterium is not resistant in the EUCAST sense, since its MIC is not strictly above the threshold defined by this body.
    Example 2 Application of the method of the invention to the determination of the sensitivity phenotype of the reference Escherichia coli strain ATCC 35421 called "EC21" to gentamicin
    A test identical to that of Example 1 is carried out for another strain of Escherichia coli, strain ATCC 35421 called "EC21" makes it possible to confirm the discriminating nature of the measurement.
    The results are shown in Figure 5.
    The reference methods assign a MIC> 256pg / mL to this strain which is therefore EUCAST resistant.
    The method of the invention confirms this result since in the case N = 5 and M = 133, 100% of the tests performed do not show a characteristic effect profile of the antibiotic agent.
    Example 3 Determination of the Minimum Inhibitory Concentration (MIC) of Two Amoxicillin Escherichia Coli Strains
    In this example, it is sought to determine the phenotype of sensitivity, and to specify a framework of the minimum inhibitory concentration of the reference Escherichia coli strain ATCC 25922 called "EC10" for an antibiotic, amoxicillin, having a mode of different from that proposed in Examples 1 and 2.
    In order to illustrate the discriminating power of this method, the same test is carried out for an amoxicillin-resistant strain of Esherichia coli ATCC 35421 called "EC21" is also presented.
    The following concentrations of amoxicillin were tested. EC10 susceptible strain (CMIREF = 6pg / mL):
    Ο μ§ / mL; 2 μg / mL; 4 μg / mL; 8 μg / mL and 16 μg / mL EC21 resistant strain (CMIREF = 256 μg / mL): 0 μg / mL; 4 μg / mL and 8 μg / mL.
    In this example, another embodiment of the proposed test corresponding to the alternative method described is illustrated.
    A solution containing the bacteria to be tested, EC10 or EC21, is used as a test sample. This solution is obtained by suspending 5107CFU / mL in water to represent a concentration potentially encountered in a clinical sample, for example a urine sample. This bacterial solution is distributed in 5 filter tubes (for example Microcon YM100 Millipore) at a rate of 150pL per tube. To each of these tubes is added a sufficient quantity for the final 250 μl of physiological medium for growth consisting in this example of a mixture of PBS of final concentration 1x (obtained from the PBS reference tablets A9162.0100 of the AppliChem brand). 0.1X TSB nutrient medium (for example obtained from Broth TSB-T Trypcase Soy broth reference 42100 bioMérieux) and amoxicillin amount to achieve respective final concentrations c0 to c4 of amoxicillin (eg Sigma-Aldricht reference A8523-10ML) as follows:
    • c0 = Opg / mL
    • Ci = 2pg / mL
    • c2 = 4pg / mL
    • c3 = 8pg / mL
    • c4 = 16pg / mL
    The tubes thus obtained are incubated for 2 hours at 37 ° C. with stirring. Centrifugation, at 1200 g for 8 minutes using a centrifuge adapted to the containers used (for example the 8415C Eppendorf brand model) then allows to recover a bacterial pellet on the filter portion of each tube and eliminate the middle. The bacterial pellets are respectively resuspended in water to carry out a washing before being again pelleted by centrifugation (1200 g for 10 minutes) always on the filter part of the tube. These pellets are distributed on a Marienfield type glass slide constituting the interface I (not functionalized in this configuration) using a swab in corresponding chambers denoted C0 to C4. In this configuration, the chambers are not necessarily isolated from a physical point of view since no exchange is possible between the different conditions. It is thus possible to use a glass slide whose virtual compartments are clearly identified for each concentration as shown in FIG. 3. The virtual compartments are defined by delimitations materialized in the present example by a marking previously carried out on the slide. on the opposite side to the one where the bacteria are deposited. The glass slide is then deposited on a "geneframe" constituting the seal J in the previously described conditioning device.
    The identification of the captured bacteria is done by a manual procedure in this example based on the visual analysis by the operator of the image acquired by means of the microspectrometer camera and a light source adapted by an experimenter. This identification makes it possible to acquire a series of at least N Raman spectra acquired on individual bacteria respectively present in each chamber C0 to C4. The number of spectra to be acquired to constitute a data set depends on the level of requirement on the performance of the tests to be performed.
    The data processing mode proposed here is identical to that of Examples 1 and 2: a first pretreatment step followed by a step of classifying the spectra acquired using a previously trained classifier. In the examples proposed below, the classifier is trained with a reference base containing "no antibiotic effect" spectra previously acquired in an antibiotic-free condition (Opg / mL) of amoxicillin of EC10 bacteria and "antibiotic effect" spectra of EC10 bacteria in the presence of 8pg / mL of amoxicillin. The results obtained are presented in the confusion matrix proposed in FIG. 6. As previously, this matrix makes it possible to demonstrate the robustness of the method by giving the results for a large number of tests.
    There is a transition in the assignment of "No ATB Effect" spectral groups to the "Antibiotic Effect" category between 4pg / mL and 8pg / mL. This strain can therefore be assigned a MIC between 4 μg / mL and 8 μg / mL according to the tests. This variability at a dilution factor is very common in this type of test, eg EUCAST indicates MIC variation ranges of [2-8] pg / mL for this ATCC 25922 strain during quality testing. CMI disk diffusion, and is therefore consistent with expected results. The result established by the reference methods is 6pg / mL for this strain which is also consistent with this result.
    The same type of experiment carried out on the "EC21" strain resistant to amoxicillin gives the results presented in Figure 7. No transition is observed and the vast majority of the groups measured is attributed to the category "No effect ATB" ". We can therefore assign a MIC> 8pg / mL to this strain with this test which is also consistent with the results obtained by the reference method.
    As shown in Figure 8, identical results are obtained by training the classifier on a reference basis again containing spectra of bacteria not exposed to antibiotics to recognize the class "No ATB effect" and bacterial spectra "Antibiotic effect Exposed to a concentration greater than the MIC of another antibiotic molecule belonging to a different family, for example the gentamicin of the preceding example.
    We find similar results to those previously exposed. This example proves that it is possible to search for the antibiotic effect of an unknown substance on the bacterial strain tested in this way and thus could be applied to the molecule screening.
    Example 4: Determination of the effect of an unknown substance on a bacterial strain.
    In this example, it is sought to determine the phenotype of sensitivity, and to specify a framework of the minimum inhibitory concentration, of a bacterial strain, for example, strains of reference Escherichia coli ATCC 25922 called "EC10", for a substance deemed unknown.
    For the purposes of the test, an antibiotic molecule known but not belonging to the antibiotic families previously used is used: ciprofloxacin of the family of fluoroquinolones.
    The embodiment of the previous example is used for this example. Only the results obtained for the first 4 concentrations will be explicitly illustrated because an antibiotic effect is quickly detected for this molecule. A series of N Raman spectra is acquired in each of the chambers from C0 to C3. The concentrations c0 to c3 used are as follows:
    • c0 = Opg / mL
    • Ci = 0.005pg / mL
    • c2 = 0.015pg / mL
    • c3 = 0.064pg / mL
    As before, the steps performed to carry out the pretreatment of the spectra are the following: • the suppression of the saturated spectra • the suppression of the cosmic rays • the realignment • the extraction of the specific bacterial signal • the suppression of the deviants • the region of interest and signal normalization
    To carry out a test, an average of N spectra are acquired for each concentration tested and the result is subtracted from an average of N spectra of the concentration c0. For the concentration c0, we choose N different spectra of the N spectra used for the subtraction of the reference state. This operation aims to get rid of all variations that are not correlated with exposure to the antibiotic under the measurement conditions. This gives a series of 4 test spectra representative of each concentration.
    In this example we choose to use an unsupervised classification method based on the search and use of at least one spectral signature characteristic of an antibiotic effect. To identify this signature, a previously acquired set of data for gentamicin and the EC10 strain known for the MIC (lpg / mL) for this antibiotic is used. The dataset consisting of the N pretreated spectra acquired on bacteria exposed to one or more concentrations above the MIC is used to extract a characteristic effect. An average of all the N (or n * N) spectra of the data set is subtracted and the average of N spectra acquired in the absence of antibiotic is subtracted from the result. This result is referred to as a reference signature. It is this reference signature that is used to qualify the data acquired by exposing bacteria to ciprofloxacin, which is unknown in this case.
    The signature set thus constructed is shown in FIG. 9. The two signatures obtained for the concentrations Ci and c3 are similar: the same peaks are modified but the intensity is here correlated with the concentration. It should be noted that this difference in intensity could be used to quantify the impact of a given concentration but only in certain strain / antibiotic configurations.
    We will use the signature extracted from the 8pg / mL gentamicin concentration to analyze the 3 sets of test spectra. To do this, we evaluate the proximity of each test spectrum to the selected signature. The evaluation of the distance between the spectrum tested and the signature will be made in this example using a simple Euclidean distance in the space of the spectra but many other distances make it possible to evaluate this proximity (Mahalanobis, Ll. ..). A threshold is defined empirically compared to other identical reference experiments previously carried out, the choice of this threshold can be optimized by conventional methods (ROC ...) according to the level of result required which can differ significantly between the applications (IVD diagnosis, pharmaceutical screening ...). The distance measure obtained is then compared with this threshold value to define the proximity between the selected signature and the difference spectra acquired in the presence of the different concentrations of the molecule deemed unknown. If the distance is below the threshold, the test is positive and an effect of the antibiotic molecule has been detected. If the distance is greater than this threshold then no effect is detected.
    In an advantageous mode, it is possible to set up several increasingly strict detection thresholds. In this example, two thresholds are used according to this principle: the first, which is less strict, makes it possible to detect a significant variation of the tested spectra while the second, which is more strict, makes it possible to qualify a close proximity of the modification with the signature. A test of the distance of the spectrum tested at the signature with respect to the first threshold is thus carried out. If the test is not passed, then no effect is detected. If the test is passed, the measured distance is less than the first threshold, so an effect is detected. A second test is then performed using the second threshold and if this test is passed, the "Antibiotic Effect" result is assigned to the complete test. If this second test is not passed then the "Other effect" result is assigned to the complete test. This configuration makes it possible to easily detect spectral modifications arriving at a given concentration but not having sufficient similarity with the reference signature. This configuration therefore simply makes it possible to overcome some of the possible hazards occurring during a test (strong inhomogeneity of the capture surface, presence of parasitic particles, etc.). A simplified diagram is presented in Figure 10.
    Another way to perform an equivalent test would be to perform a test using directly the standard, Euclidean or otherwise, of the tested spectrum and compare it to a threshold of significance chosen to ignore the classical variations related to the mode of measurement (sensor noise level, biological variability, ...) and then perform the test at a single strict threshold. If the standard exceeds a certain threshold then the spectrum is significantly different from a near-zero difference spectrum if there were no changes in the concentration and can then be compared strictly to the reference signature. for example by measuring its distance to the signature in the sense of the standard used.
    The results presented in FIG. 11 are obtained. The detection of an effect is thus observed for concentrations greater than 0.005 μg / ml. An antibiotic effect of ciprofloxacin can therefore be attributed to the strain tested for concentrations greater than 0.005pg / mL. This test would therefore define a concentration of 0.005pg / mL as a MIC. A new test could possibly be done by adding lower concentrations between 0 and 0.005pg / mL if necessary. The EUCAST data for this strain indicates a known MIC of 0.008 μg / mL and an acceptable range of 0.004 μg / mL to 0.016 μg / mL. A test carried out with an etest (bioMérieux) adequate to measure a MIC of 0.008pg / mL which confirms that the result obtained is in accordance with the reference methods.
    权利要求:
    Claims (16)
    [1" id="c-fr-0001]
    1. A method for determining the reaction of at least one bacterium of interest to its exposure to an antibiotic using a Raman spectroscopy analysis and comprising the following steps: There is a biological sample capable of containing the said bacteria. At least two fractions of said sample each comprising one or more living bacteria of interest are prepared. At least one bacterium of living interest is captured in each fraction by means of a binding partner. one of the fractions to at least one concentration of at least one given antibiotic, the other of the fractions being the control fraction. The bacterium (s) of interest contained in the fractions are subjected to an incident light and the resultant light obtained by Raman scattering by the bacterium (s) of interest by Raman spectroscopy to obtain as many Raman spectra as bacteria, is analyzed. aite said spectra to obtain a signature of the reaction of the or each bacterium (s) of interest to the exposure of said antibiotic and the control, the signature thus obtained by bacterium of interest is compared to a reference base defined under the same conditions as above, for different bacteria and at least said antibiotic, and a clinical profile of sensitivity of said bacterium of interest to said antibiotic is defined.
    [2" id="c-fr-0002]
    2. Method according to claim 1, characterized in that more than two fractions of said sample are prepared and at least two fractions are exposed to increasing concentrations, respectively, of said antibiotic.
    [3" id="c-fr-0003]
    3. Method according to claim 1 or 2, characterized in that the concentrations of the antibiotic to which the fraction or fractions are respectively exposed, are within a range of values including at least one selected value or at least one formant values. framing at least one value chosen from values characteristic of an antibiotic / species pair such as the epidemiological cut-off, the clinical breakpoint (s) or concentration panels used in the reference methods.
    [4" id="c-fr-0004]
    4. Method according to any one of claims 1 to 3, characterized in that the bacterium (s) of interest present in the fractions are captured by a binding partner which is immobilized directly or indirectly on a support.
    [5" id="c-fr-0005]
    5. Method according to claim 4, characterized in that the binding partner is capable of interacting specifically with the bacterium (s) of interest and is preferably chosen from proteins, antibodies, antigens, aptamers. , phages, phage proteins.
    [6" id="c-fr-0006]
    6. Process according to any one of Claims 1 to 5, characterized in that the captured bacteria are identified and sorted, for example by imaging or spectrophotometry.
    [7" id="c-fr-0007]
    7. Method according to any one of claims 1 to 6, characterized in that, before subjecting the bacteria or bacteria of interest to incident light, the bacteria that have not been captured are eliminated.
    [8" id="c-fr-0008]
    8. Process according to claim 7, characterized in that the bacteria are eliminated, before or after the step of exposure to the antibiotic.
    [9" id="c-fr-0009]
    9. Process according to any one of claims 1 to 8, characterized in that, after the step of exposing the fractions, said fractions and the control fraction are concentrated and then subjected to the capture step.
    [10" id="c-fr-0010]
    10. Method according to any one of claims 1 to 9, characterized in that the antibiotic is in a physiological medium at least to maintain the live bacteria or bacteria.
    [11" id="c-fr-0011]
    11. Method according to any one of claims 1 to 10, characterized in that the exposure to the antibiotic is carried out at a temperature of at least 18 ° C of at most 40 ° C.
    [12" id="c-fr-0012]
    12. Method according to any one of claims 1 to 11, characterized in that the exposure to the antibiotic is carried out for a so-called incubation time of at least 10 minutes and not more than 4 hours.
    [13" id="c-fr-0013]
    13. Process according to any one of the preceding claims, characterized in that, to obtain said signature, for each fraction exposed to the antibiotic, the Raman spectra or the Raman spectra of the control sample are subtracted from the Raman spectra respectively of said samples.
    [14" id="c-fr-0014]
    14. Method according to any one of claims 1 to 13, characterized in that one determines the Sensitive, Intermediate or Resistant status of the strain of interest to said antibiotic.
    [15" id="c-fr-0015]
    15. The method of claim 14, characterized in that determines the minimum inhibitory concentration (MIC) of said strain said antibiotic.
    [16" id="c-fr-0016]
    16. The method of claim 14 or 15, characterized in that each fraction comprises at least 2, preferably at least 5, bacteria of interest to obtain at least 2, preferably at least 5 signals.
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    同族专利:
    公开号 | 公开日
    EP3380828B1|2019-11-06|
    CN108700521B|2022-02-25|
    US10704075B2|2020-07-07|
    EP3380828A1|2018-10-03|
    JP2019506590A|2019-03-07|
    WO2017089727A1|2017-06-01|
    US20180355399A1|2018-12-13|
    FR3044415B1|2017-12-01|
    JP6912477B2|2021-08-04|
    CN108700521A|2018-10-23|
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    优先权:
    申请号 | 申请日 | 专利标题
    FR1561446A|FR3044415B1|2015-11-27|2015-11-27|METHOD FOR DETERMINING THE REACTION OF A MICROORGANISM TO ITS EXPOSURE TO AN ANTIBIOTICS|FR1561446A| FR3044415B1|2015-11-27|2015-11-27|METHOD FOR DETERMINING THE REACTION OF A MICROORGANISM TO ITS EXPOSURE TO AN ANTIBIOTICS|
    CN201680080179.3A| CN108700521B|2015-11-27|2016-11-25|Method for determining the response of a microorganism to its exposure to a compound|
    US15/779,295| US10704075B2|2015-11-27|2016-11-25|Method for determining the reaction of a microorganism to its exposure to a chemical compound|
    EP16815603.2A| EP3380828B1|2015-11-27|2016-11-25|Method for determining the reaction of a microorganism to its exposure to a chemical compound|
    PCT/FR2016/053100| WO2017089727A1|2015-11-27|2016-11-25|Method for determining the reaction of a microorganism to its exposure to a chemical compound|
    JP2018527229A| JP6912477B2|2015-11-27|2016-11-25|How to determine the response of microorganisms to exposure to chemicals|
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