Clinical Impact and Provider Acceptability of Real-Time Antimicrobial Stewardship Decision Support for Rapid Diagnostics in Children With Positive Blood Culture Results

Messacar, Kevin; Hurst, Amanda L.; Child, Jason; Campbell, Kristen; Palmer, Claire; Hamilton, Stacey; Dowell, Elaine; Robinson, Christine C.; Parker, Sarah K.; Dominguez, Samuel R.

doi:10.1093/jpids/piw047

Cited by 61 publications

(67 citation statements)

References 40 publications

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“…Incorporating real-time decision support at the time of result reporting ensures that the right interpretation of the test result leads to the right antimicrobial being prescribed from the start, rather than correcting misinterpretations and rectifying suboptimal antimicrobial use after treatment has reached the patient. This approach has been shown to be acceptable to providers and has not led to decreases in infectious disease consultations (29). Although this approach requires a significant investment of antimicrobial stewardship resources, it capitalizes on the investment made in expensive rapid diagnostic technologies, ensuring that these laboratory tests are optimally influencing patient care.…”

Section: Antimicrobial Stewardshipmentioning

confidence: 99%

“…These stakeholder liaisons can be helpful in gathering ongoing feedback during the implementation process. Provider surveys are another method to obtain ongoing feedback regarding the accuracy, timeliness, impact, and acceptability of the newly implemented test (29). During the rollout period, telephone and email hotlines can be helpful for troubleshooting unforeseen issues and providing education and support for end users who may not be familiar with the new technology.…”

Section: Antimicrobial Stewardshipmentioning

confidence: 99%

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Implementation of Rapid Molecular Infectious Disease Diagnostics: the Role of Diagnostic and Antimicrobial Stewardship

et al. 2017

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New rapid molecular diagnostic technologies for infectious diseases enable expedited accurate microbiological diagnoses. However, diagnostic stewardship and antimicrobial stewardship are necessary to ensure that these technologies conserve, rather than consume, additional health care resources and optimally affect patient care. Diagnostic stewardship is needed to implement appropriate tests for the clinical setting and to direct testing toward appropriate patients. Antimicrobial stewardship is needed to ensure prompt appropriate clinical action to translate faster diagnostic test results in the laboratory into improved outcomes at the bedside. This minireview outlines the roles of diagnostic stewardship and antimicrobial stewardship in the implementation of rapid molecular infectious disease diagnostics.

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Section: Antimicrobial Stewardshipmentioning

confidence: 99%

Section: Antimicrobial Stewardshipmentioning

confidence: 99%

Implementation of Rapid Molecular Infectious Disease Diagnostics: the Role of Diagnostic and Antimicrobial Stewardship

et al. 2017

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“…Studies evaluating the impact of rapid diagnostic methods for blood cultures in children are more limited. Initial studies focused primarily on the diagnostic accuracy and functionality of the tests [12–16]; however, more recent reports have shown benefits of rapid identification on overall antibiotic use in children [2, 17–22]. …”

Section: Introductionmentioning

confidence: 99%

“…Prior pediatrics studies evaluating the impact of rapid blood culture diagnostics have had either limited formal ASP involvement [20, 21] or implemented stewardship simultaneously with the rapid diagnostic test [22]. Our institution has had an active ASP since 2010.…”

Section: Introductionmentioning

confidence: 99%

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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“…Syndromic and POC molecular testing methods have revolutionized the diagnosis of infectious diseases by increasing the accuracy of microbial detection, substantially decreasing the time needed to generate clinically useful laboratory test results, and enabling the performance of laboratory-quality testing at or near the point of care by nonlaboratorians [9]. In return, patients are able to receive appropriate treatment sooner, avoiding prolonged exposure to unnecessary antimicrobial drugs, thereby avoiding the selection of drug-resistant pathogens and strengthening antimicrobial stewardship practices [9][10][11]. In addition, many of these methods permit the rapid detection of pathogens that pose significant infection control and public health hazards, including high-consequence and travel-related pathogens (eg, Bacillus anthracis, Ebola virus, and Plasmodium spp.)…”

Section: Significancementioning

confidence: 99%

Syndromic and Point-of-Care Molecular Testing

Relich

Abbott

2018

Advances in Molecular Pathology

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KEYWORDSSyndromic panels Point-of-care molecular diagnostics Multiplex PCR Group A Streptococcus Influenza-like illness Meningitis Gastroenteritis Blood stream infections KEY POINTSSyndromic and point-of-care molecular diagnostic testing methods have revolutionized infectious disease testing by permitting the simultaneous detection of multiple pathogens and drug resistance mechanisms directly from clinical specimens and positive blood cultures. Syndromic testing panels currently include those designed for the detection of pathogens responsible for bloodstream, central nervous system, gastrointestinal tract, and respiratory tract infections as well as some biothreat agents. Point-of-care molecular diagnostic systems afford providers the ability to generate laboratory-quality results without the need for confirmatory testing of negative specimens. Implementation of syndromic and point-of-care molecular infectious disease testing methods has curbed the unnecessary use of antibiotics, strengthening antimicrobial stewardship practices. Development of methods for the detection of infectious diseases beyond those that are detectable by current technologies is an area of investigation.

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Clinical Impact and Provider Acceptability of Real-Time Antimicrobial Stewardship Decision Support for Rapid Diagnostics in Children With Positive Blood Culture Results

Abstract: Real-time AS decision support for rapid diagnostics is associated with improved antimicrobial use and high satisfaction ratings by providers.

Cited by 61 publications

References 40 publications

Implementation of Rapid Molecular Infectious Disease Diagnostics: the Role of Diagnostic and Antimicrobial Stewardship

Implementation of Rapid Molecular Infectious Disease Diagnostics: the Role of Diagnostic and Antimicrobial Stewardship

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 and Point-of-Care Molecular Testing

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