Assessment of Time to Clinical Response in Patients with Sepsis Treated Before and After Implementation of a Matrix-Assisted Laser Desorption Ionization Time-of-Flight Blood Culture Identification Algorithm

Abstract

OBJECTIVE To evaluate time to clinical response before and after implementation of rapid blood culture identification technologies. DESIGN Before-and-after trial. SETTING Large, tertiary, urban, academic health-sciences center. PATIENTS Patients >18 years old with sepsis and concurrent bacteremia or fungemia were included in the study; patients who were pregnant, had polymicrobial septicemia, or were transferred from an outside hospital were excluded. INTERVENTION Prior to the intervention, polymerase chain reaction was used to identify Staphylococcus species from positive blood cultures, and traditional laboratory techniques were used to identify non-staphylococcal species. After the intervention, matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) assay and FilmArray were also used to identify additional species. During both periods, the antimicrobial stewardship team provided prospective audit and feedback for all patients on antibiotics. RESULTS A total of 219 patients were enrolled in the study: 115 patients prior to the intervention and 104 after the intervention. The median time to clinical response was statistically significantly shorter in the postintervention group than in the preintervention group (2 days vs 4 days, respectively; P=.002). By Cox regression, the implementation of MALDI-TOF and FilmArray was associated with shorter time to clinical response (hazard ratio [HR], 1.360; 95% confidence interval [CI], 1.018-1.816). After controlling for potential confounders, the study group was not independently associated with clinical response (adjusted HR, 1.279; 95% CI, 0.955-1.713). Mortality was numerically, but not statistically significantly, lower in the postintervention group than in the preintervention group (7.6% vs 11.4%; P=.342). CONCLUSIONS In the setting of an existing antimicrobial stewardship program, implementation of MALDI-TOF and FilmArray was associated with improved time to clinical response. Further research is needed to fully describe the effect of antimicrobial stewardship programs on time to clinical response. Infect Control Hosp Epidemiol 2016;37:916-923.

Usefulness of matrix-assisted laser desorption ionization time-of-flight mass spectrometry to identify pathogens, including polymicrobial samples, directly from blood culture broths

“…However, the infecting bacteria investigated by Hansen et al were relatively rare Gram-positive cocci, such as Ruminococcus species 11. Furthermore, treatment following rapid organism identification by TOF-MS has been shown to lead to reduced mortality in severe sepsis cases after implementation of TOF-MS in combination with BC 14. Furthermore, TOF-MS recently has been shown to reduce the use of wide-spectrum antibiotics in infection control when employed as part of an antimicrobial stewardship program 15.…”

Impact of matrix-assisted laser desorption/ionization time of flight mass spectrometric evaluation on the clinical outcomes of patients with bacteremia and fungemia in clinical settings lacking an antimicrobial stewardship program: a pre-post quasi experimental study

“…Several studies have shown that MALDI-TOF MS combined with an ASP improved clinical outcomes in patients with positive blood cultures [ 12 – 18 ]. Huang et al [ 13 ] reported that the use of MALDI-TOF MS combined with an ASP in patients with bacteremia and candidemia was associated with improved clinical outcomes, including the time to effective therapy (30.1 vs. 20.4 h, P = 0.021), 30-day all-cause mortality (20.3% vs. 12.7%, P = 0.021), and length of intensive care unit (ICU) stay (14.9 vs. 8.3 days, P = 0.014) in univariate analyses, and that ASP introduction was related to a nonsignificant trend toward reduced mortality (odds ratio, 0.55; P = 0.075) in multivariate analysis.…”

Clinical impact of matrix‐assisted laser desorption ionization‐time of flight mass spectrometry combined with antimicrobial stewardship interventions in patients with bloodstream infections in a Japanese tertiary hospital

“…Compared with traditional biochemical methods, MALDI‐TOF MS offers substantially faster and more accurate identification of isolated organisms . Several studies have shown that MALDI‐TOF MS combined with an antimicrobial stewardship program (ASP) improves clinical outcomes in patients with positive blood cultures . However, in many hospitals around the world, ASPs are not in place because of restrictions on medical resources .…”

“…[6][7][8] Several studies have shown that MALDI-TOF MS combined with an antimicrobial stewardship program (ASP) improves clinical outcomes in patients with positive blood cultures. [8][9][10][11][12][13][14] However, in many hospitals around the world, ASPs are not in place because of restrictions on medical resources. 15 Furthermore, Jeon et al reported that evaluation using MALDI-TOF MS in the absence of an ASP does not improve clinical outcomes.…”