Is It Actionable? An Evaluation of the Rapid PCR-Based Blood Culture Identification Panel on the Management of Gram-Positive and Gram-Negative Blood Stream Infections

Abstract

BackgroundThere is growing interest in the use of rapid blood culture identification (BCID) in antimicrobial stewardship programs (ASPs). Although many studies have looked at its clinical and economic utility, its comparative utility in gram-positive and gram-negative blood stream infections (BSIs) has not been as well characterized.MethodsThe study was a quasi-experimental retrospective study at the Mayo Clinic in Phoenix, Arizona. All adult patients with positive blood cultures before BCID implementation (June 2015 to December 2015) and after BCID implementation (June 2016 to December 2016) were included. The outcomes of interest included time to first appropriate antibiotic escalation, time to first appropriate antibiotic de-escalation, time to organism identification, length of stay, infectious diseases consultation, discharge disposition, and in-hospital mortality.ResultsIn total, 203 patients were included in this study. There was a significant difference in the time to organism identification between the pre- and post-BCID cohorts (27.1 hours vs 3.3 hours, P < .0001). BCID did not significantly reduce the time to first appropriate antimicrobial escalation or de-escalation for either gram-positive BSIs (GP-BSIs) or gram-negative BSIs (GN-BSIs). Providers were more likely to escalate antimicrobial therapy in GP-BSIs after gram stain and more likely to de-escalate therapy in GN-BSIs after susceptibilities. Although there were no significant differences in changes in antimicrobial therapy for organism identification by BCID vs traditional methods, more than one-quarter of providers (28.1%) made changes after organism identification. There were no differences in hospital length of stay or in-hospital mortality comparing pre- vs post-BCID.ConclusionsAlthough BCID significantly reduced the time to identification for both GP-BSIs and GN-BSIs, BCID did not reduce the time to first appropriate antimicrobial escalation and de-escalation.

The Impact of the FilmArray-Based Detection of Microbial Pathogens from Positive Blood Culture Vials on the Time to Optimal Antimicrobial Regimen in Intensive Care Units of the Helios University Clinic Wuppertal, Germany

“…Even though previous studies postulated the effect on patient outcome in regard to the length of stay, mortality, or length of ventilation [11,13,15,20,21], we were unable to assess any potential beneficial outcomes reading these aspects. The reason for this can be that it is possible that the effect of the earlier optimization is not high enough to affect the other parameters/variables.…”

Performance of the Reveal Rapid Antibiotic Susceptibility Testing System on Gram-Negative Blood Cultures at a Large Urban Hospital

“…ID can be entered by the user at any time during or after the AST run, after which the appropriate breakpoints are automatically applied by the software, enabling compatibility with workflows not only with multiplexed rapid PCR but also ID methods that require 4 to 5 h of sample preparation for MALDI-TOF-based rapid identification. Thus, with Reveal AST and a rapid ID method, both ID and AST can be obtained within 5 h and as early as 3.5 h following Gram stain results, enabling appropriate therapeutic adjustment at that time ( 19 ). A subsequent study in which a rapid direct-from-blood culture ID method is utilized will be required to quantify the time from availability of positive blood culture to integrated and actionable ID+AST results using Reveal.…”

New Microbiological Techniques for the Diagnosis of Bacterial Infections and Sepsis in ICU Including Point of Care

“…Impact on clinical outcomes has been highly variable in studies assessing length of stay, mortality and re-admission [ 110 – 112 ]. The reasons for this have not been rigorously studied but based on other stewardship research likely pertain to prescribing behaviour, lack of familiarity, and experience or expert knowledge in the actionability of RDT results [ 113 , 114 ]. The likelihood of a clinical de-escalation of antimicrobials overnight is low, even if microbiology and AMS teams extend their hours of operation for a 24/7 model, reflecting most likely a combination of either junior clinical staff or caretaker culture overnight [ 105 ].…”