bThe performance of the FilmArray blood culture identification (BCID) panel has been studied in adult patients. We describe here an evaluation of this assay for the rapid identification of pathogens in Bactec Peds Plus/F and Bactec standard anaerobic/F bottles that contained blood samples from pediatric patients at a tertiary care children's hospital. Bloodstream infections are associated with high fatality rates. Rapid organism identification and susceptibility testing may improve patient outcomes (1, 2). In 2013, the FDA cleared a rapid and automated multiplex PCR assay, the FilmArray blood culture identification (BCID) (BioFire Diagnostics, Salt Lake City, UT), which directly identifies common pathogens, including 7 genera/ species of Gram-positive bacteria, 10 genera/species of Gram-negative bacteria, and 5 species of Candida (as well as 3 resistance determinants) in the positive blood culture bottles. The assay requires about 2 min of hands-on sample processing time and 1 h of instrument time (which includes DNA isolation, amplification, and detection), which promises to shorten the pathogen identification time by Ն1 to 2 days.However, a demonstration of the clinical performance of the assay by the manufacturer was limited to the BD Bactec Plus aerobic/F medium. There are 5 articles reporting the performance of the assay (3-7), but the specimens in these studies were collected mainly from adult patients, and there was very little information regarding the pediatric bottles/media used for testing. There is a paucity of performance data of this assay for the testing of pediatric bottles and pediatric patients. We sought to evaluate the performance of the FilmArray BCID system on pediatric specimens by comparing the results to those of conventional blood culture workup methods, which included a subculture of broth onto solid medium for further pathogen identification and antimicrobial susceptibility testing using phenotypic assays.(The results of this study were presented in part at the 24th European Congress of Clinical Microbiology and Infectious Diseases in Barcelona, Spain, 10 to 13 May 2014).The study was conducted during an 8-month period from January to August in 2013. Blood culture specimens were collected from our academic tertiary care pediatric medical center. Each blood culture included a Bactec Peds Plus/F bottle and a Bactec standard anaerobic/F bottle (Becton, Dickinson, Cockeysville, MD). All bottles were incubated in the Bactec FX continuous monitoring blood culture instrument. Prospectively, the FilmArray BCID assay was performed after routine Gram stain examination with the first bottle (Peds Plus/F or standard anaerobic/F bottle) that signaled positive growth. The results of the BCID assay were compared to those obtained using standard bacterial identification and antibiotic susceptibility using the MicroScan system (Siemens, Sacramento, CA). The MicroScan panels used included PC 33 for Gram-positive bacteria, NC 50 for Gram-negative bacteria, and RY-ID for yeast identification. They were p...

Healthcare provider education can cost-effectively reduce the frequency of C difficile testing and CDI misdiagnosis by improving test utilization among low-risk children.

The performance of the Illumigene group A Streptococcus assay was evaluated by comparing it to culture using 437 consecutive throat swabs. The Illumigene assay was also directly compared to PCR with 161 samples. This Illumigene assay is rapid and easy to perform. The assay also has high sensitivity (100%) compared to culture or PCR and high specificity (99.2%) compared to PCR. A total of 8.8% of the isolates were erythromycin resistant, and 6.9% were clindamycin resistant. Streptococcus pyogenes (group A streptococcus [GAS]) causes various infections, including acute pharyngitis in children. Rapid and accurate laboratory diagnosis is important for antibiotic therapy that prevents rheumatic fever and probably invasive infections (1). Current standard testing methods include rapid antigen detection, with about 70 to 80% sensitivity, and culture, which takes 24 to 48 h (2). A new molecular method, the Illumigene group A Streptococcus assay, based on loop-mediated isothermal amplification (LAMP) technology for testing GAS, has been developed by Meridian Bioscience and has recently been cleared by the FDA. The target region of the assay is in the GAS pyrogenic exotoxin B (speB) gene (3,4). In this prospective study, the Illumigene group A Streptococcus assay was compared to standard bacterial culture and to PCR targeting the ptsI (phosphotransferase) gene to evaluate its clinical performance.Specimens. Throat swabs routinely submitted for GAS testing by rapid antigen and culture methods were collected from symptomatic children at Ann and Robert H. Lurie Children's Hospital of Chicago. Each specimen was collected with the double-swab system with a liquid Stuart transport medium (Copan Diagnostics, Inc., Murrieta, CA). One swab was used for rapid antigen assay. The second swab was used for culture and the Illumigene group A Streptococcus assay. No patient was enrolled into the study more than once. The study was approved by the Institutional Review Board of Ann and Robert H. Lurie Children's Hospital of Chicago.Illumigene group A Streptococcus assay. One swab was plated onto agar plates for culture and then was used to perform the Illumigene group A Streptococcus assay as described in the manufacturer's product insert. Briefly, the sample in the supplied sample preparation buffer was heated to 95°C for 10 min. Heated samples were transferred to "test" and "control" chambers that contained lyophilized amplification reagents. Both amplification and detection took place on the Illumipro-10 device. The whole process time from preparation to result reading for 1 to 10 specimens was approximately 1 h.Culture and susceptibility. Standard GAS culture was performed with 5% sheep blood agar. GAS identification was based on colony morphology, Gram stain, catalase test, and serogrouping using reagents from PathoDX Strep Grouping distributed by Remel, Lenexa, KS (2). Erythromycin, clindamycin, and levofloxacin susceptibility testing was performed with MICroSTREP Plus panels, and the results were read using the MicroScan Walkaway in...

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