Clinical and economic impact of antimicrobial stewardship interventions with the FilmArray blood culture identification panel

Pardo, Joe; Klinker, Kenneth P.; Borgert, Samuel J.; Butler, Brittany M.; Giglio, Patricia G.; Rand, Kenneth H.

doi:10.1016/j.diagmicrobio.2015.10.023

Cited by 98 publications

(93 citation statements)

References 20 publications

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“…Beal et al, using a multiplex DNA hybridization assay, found that the rapid detection of MSSA (vs. MRSA) allowed for a reduction in time to optimal antibiotics of 21 h for adult patients [33]. Our findings for both CoNS and MSSA are similar to those of Pardo et al who looked at the impact of the BCID panel on the management of patients with blood cultures positive for gram-positive organisms [34]. …”

Section: Discussionsupporting

confidence: 82%

A Retrospective Study of the Impact of Rapid Diagnostic Testing on Time to Pathogen Identification and Antibiotic Use for Children with Positive Blood Cultures

et al. 2016

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IntroductionRapid identification of bloodstream pathogens provides crucial information that can improve the choice of antimicrobial therapy for children. Previous impact studies have primarily focused on adults. Our objective was to evaluate the impact of rapid testing in a children’s hospital on time to organism identification and antibiotic use in the setting of an established antimicrobial stewardship program.MethodsWe conducted a retrospective study over three consecutive time periods (spanning January 2013–August 2015) as our hospital sequentially introduced two rapid testing methods for positive blood cultures. An antimicrobial stewardship program was active throughout the study. In the baseline period, no rapid diagnostic methods were routinely utilized. In the second period (PNAFISH), a fluorescent in situ hybridization test was implemented for gram-positive organisms and in the third a rapid multiplex PCR (rmPCR) test was employed. For children with positive blood cultures, time to organism identification use and duration of select antimicrobial therapies were compared between periods.ResultsPositive blood cultures were analyzed. Median overall time to organism identification was 23, 11, and 0 h in the baseline, PNAFISH, and rmPCR periods, respectively (p < 0.001 for both PNAFISH and rmPCR vs. baseline). For gram-negative organisms, only rmPCR performed significantly faster than baseline (p < 0.001). The duration of vancomycin use for coagulase-negative staphylococci was shorter in both the PNAFISH and rmPCR periods (mean 31 h in the baseline period, 12 and 14 h in the PNAFISH and rmPCR periods, respectively). For MSSA bacteremia, use of vancomycin was significantly decreased only in the rmPCR period (32% of patients vs. 64 and 72% in the baseline and PNAFISH periods; mean duration of 9 h vs. 30 and 26 h). There was no difference in use or duration of broad-spectrum gram-negative therapy across the three time periods.ConclusionRapid diagnostic testing for children with positive blood cultures results in faster time to identification and can influence antibiotic prescribing in the setting of active antimicrobial stewardship particularly for gram-positive pathogens.FundingMerck.

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Section: Discussionsupporting

confidence: 82%

A Retrospective Study of the Impact of Rapid Diagnostic Testing on Time to Pathogen Identification and Antibiotic Use for Children with Positive Blood Cultures

et al. 2016

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“…The BCID group had a shorter time to effective therapy (5 h; P Ͻ 0.001) than did the control group (15 h) or the antimicrobial stewardship group (13 h); however, there was no difference with respect to the mortality rate, 30-day readmission rate, intensive care unit length of stay, or cost of care (22). In a pre/postintervention study by Pardo et al, the implementation of the BCID panel led to a shorter duration of empirical vancomycin use for patients with contaminated blood cultures (P ϭ 0.005) and methicillin-susceptible S. aureus bacteremia (P Ͻ 0.001), earlier effective therapy for patients with vancomycin-resistant enterococcal bacteremia (P ϭ 0.047), and shorter postculture lengths of stay for those with CoNS bacteremia (P Ͻ 0.008) than with conventional identification and susceptibility testing using phenotypic methods and the Vitek 2 system (bioMérieux) (23). Another pre/ postintervention study involving 300 hospitalized children with bacteremia noted decreases in the median times to optimal therapy (26.7 h versus 60.2 h; P ϭ 0.001) and antibiotic initiation for cultures with contaminants (26% versus 76%; P Ͻ 0.001) in the BCID group compared to the preintervention group, for which MicroScan (Siemens Healthcare Diagnostics, Inc.), RapID NF, and RapID NH (Remel Inc.) were used for bacterial identification and the API 20C Aux system (bioMérieux) was used for the identification of yeasts, alongside rapid penicillin binding protein 2= latex agglutination testing (Oxoid, Basingstoke, United Kingdom) (24).…”

Section: Clinical and Economic Impactsmentioning

confidence: 99%

Syndromic Panel-Based Testing in Clinical Microbiology

et al. 2018

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The recent development of commercial panel-based molecular diagnostics for the rapid detection of pathogens in positive blood culture bottles, respiratory specimens, stool, and cerebrospinal fluid has resulted in a paradigm shift in clinical microbiology and clinical practice. This review focuses on U.S. Food and Drug Administration (FDA)-approved/cleared multiplex molecular panels with more than five targets designed to assist in the diagnosis of bloodstream, respiratory tract, gastrointestinal, or central nervous system infections. While these panel-based assays have the clear advantages of a rapid turnaround time and the detection of a large number of microorganisms and promise to improve health care, they present certain challenges, including cost and the definition of ideal test utilization strategies (i.e., optimal ordering) and test interpretation.

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“…The U.S. Food and Drug Administration (FDA) has cleared some of these diagnostic tests, and some are available only in Europe. Several of the tests have been shown to decrease mortality, to improve time to effective antimicrobial therapy, to shorten hospital stays, and to decrease health care costs (14)(15)(16)(17). Several of the tests provide information on the presence or absence of resistance genes, but none of them provides rapid phenotypic antimicrobial susceptibility testing (AST) results.…”

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confidence: 99%

Evaluation of the Accelerate Pheno System: Results from Two Academic Medical Centers

et al. 2018

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Rapid diagnostic tests are needed to improve patient care and to combat the problem of antimicrobial resistance. The Accelerate Pheno system (Accelerate Diagnostics, Tucson, AZ) is a new diagnostic device that can provide rapid bacterial identification and antimicrobial susceptibility test (AST) results directly from a positive blood culture. The device was compared to the standard of care at two academic medical centers. There were 298 blood cultures included in the study, and the Accelerate Pheno system provided a definitive identification result in 218 instances (73.2%). The Accelerate Pheno system provided a definitive and correct result for 173 runs (58.1%). The Accelerate Pheno system demonstrated an overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 94.7%, 98.9%, 83.7%, and 99.7%, respectively. An AST result was available for analysis in 146 instances. The overall category agreement was 94.1% with 12 very major errors, 5 major errors, and 55 minor errors. After a discrepancy analysis, there were 5 very major errors and 4 major errors. The Accelerate Pheno system provided an identification result in 1.4 h and an AST result in 6.6 h; the identification and AST results were 41.5 h and 48.4 h faster than those with the standard of care, respectively. This study demonstrated that the Accelerate Pheno system is able to provide fast and accurate organism identification and AST data. A limitation is the frequency with which cultures required the use of alternative identification and AST methods.

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Clinical and economic impact of antimicrobial stewardship interventions with the FilmArray blood culture identification panel

Cited by 98 publications

References 20 publications

A Retrospective Study of the Impact of Rapid Diagnostic Testing on Time to Pathogen Identification and Antibiotic Use for Children with Positive Blood Cultures

A Retrospective Study of the Impact of Rapid Diagnostic Testing on Time to Pathogen Identification and Antibiotic Use for Children with Positive Blood Cultures

Syndromic Panel-Based Testing in Clinical Microbiology

Evaluation of the Accelerate Pheno System: Results from Two Academic Medical Centers

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