Rapid detection of Gram-negative bacteria and their drug resistance genes from positive blood cultures using an automated microarray assay

Han, Eunhee; Park, Dong-Jin; Kim, Yukyoung; Yu, Jin Kyung; Park, Kang Gyun; Park, Yeon-Joon

doi:10.1016/j.diagmicrobio.2014.10.009

Cited by 16 publications

(14 citation statements)

References 36 publications

(40 reference statements)

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“…Such a disadvantage is not the case with methods such as mass spectrometry-based identification direct from blood culture broth. Also, failure to detect some mixed infections is a known limitation of the BC-GN assay that was consistent with our findings (19,24). The discordance seen in the case in which BC-GN was negative for panel targets but conventional methods identified K. pneumoniae could possibly have been Klebsiella variicola, a species that the BC-GN panel does not recognize but that is identified as K. pneumoniae with conventional biochemical identification (17,25).…”

Section: Discussionsupporting

confidence: 76%

“…On a practical level, it required ϳ3.5 h from the time of Gram stain on the positive blood culture broth to entry of BC-GN results into electronic medical records. This is longer than the 2 to 2.5 h cited in most studies because we included samples that had delayed turnaround times due to gaps in laboratory coverage (9,18,19). During the implementation of the assay at our institution, providers were notified of the assay and its interpretation via laboratory bulletin.…”

Section: Discussionmentioning

confidence: 99%

“…It is therefore imperative for laboratories to understand if and how such testing impacts patient outcome in order to justify its use. Compared to other studies that have used simulated samples, proposed theoretical benefits from antimicrobial interventions, and/or excluded polymicrobial cultures, this study aimed to provide a practical reference for the effects of this technology on laboratory turnaround times and patient care in a real-world hospital setting (16)(17)(18)(19)(20)(21)(22). While others have bundled rapid bloodstream infection diagnostics with improved stewardship practices for their analyses (9,17), it has been shown that antimicrobial stewardship interventions for Gram-negative bacteremia alone can improve outcomes (23).…”

Section: Discussionmentioning

confidence: 99%

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Clinical Impact of Laboratory Implementation of Verigene BC-GN Microarray-Based Assay for Detection of Gram-Negative Bacteria in Positive Blood Cultures

et al. 2016

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c Gram-negative bacteremia is highly fatal, and hospitalizations due to sepsis have been increasing worldwide. Molecular tests that supplement Gram stain results from positive blood cultures provide specific organism information to potentially guide therapy, but more clinical data on their real-world impact are still needed. We retrospectively reviewed cases of Gram-negative bacteremia in hospitalized patients over a 6-month period before (n ‫؍‬ 98) and over a 6-month period after (n ‫؍‬ 97) the implementation of a microarray-based early identification and resistance marker detection system (Verigene BC-GN; Nanosphere) while antimicrobial stewardship practices remained constant. Patient demographics, time to organism identification, time to effective antimicrobial therapy, and other key clinical parameters were compared. The two groups did not differ statistically with regard to comorbid conditions, sources of bacteremia, or numbers of intensive care unit (ICU) admissions, active use of immunosuppressive therapy, neutropenia, or bacteremia due to multidrug-resistant organisms. The BC-GN panel yielded an identification in 87% of Gram-negative cultures and was accurate in 95/97 (98%) of the cases compared to results using conventional culture. Organism identifications were achieved more quickly post-microarray implementation (mean, 10.9 h versus 37.9 h; P < 0.001). Length of ICU stay, 30-day mortality, and mortality associated with multidrug-resistant organisms were significantly lower in the postintervention group (P < 0.05). More rapid implementation of effective therapy was statistically significant for postintervention cases of extended-spectrum beta-lactamase-producing organisms (P ‫؍‬ 0.049) but not overall (P ‫؍‬ 0.12). The Verigene BC-GN assay is a valuable addition for the early identification of Gram-negative organisms that cause bloodstream infections and can significantly impact patient care, particularly when resistance markers are detected. Bloodstream infection remains one of the deadliest and costliest conditions in the United States, more than doubling between 2000 and 2008 and becoming the sixth most common reason for hospitalization (1). Gram-negative bacteremia has become an ever more pressing public health concern, as numbers across the globe continue to rise (2, 3). Although Gram-negative organisms are only responsible for ϳ30% of cases of hospitalacquired infections, they account for 70% of such cases in intensive care units (ICU) in the United States (4). These organisms, including multidrug-resistant (MDR) Pseudomonas aeruginosa and extended-spectrum beta-lactamase (ESBL) or carbapenemresistant Enterobacteriaceae (CRE), are associated with higher mortality rates (1, 3, 4).A timely and appropriate antimicrobial therapy selection is of particular importance. Delays in effective therapy and ineffective empirical therapy are associated with increased patient mortality (4-7). Growing evidence suggests that appropriate, early antibiotic therapy can improve patient outcomes (3,4,6,8). New rapid m...

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical Impact of Laboratory Implementation of Verigene BC-GN Microarray-Based Assay for Detection of Gram-Negative Bacteria in Positive Blood Cultures

et al. 2016

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“…Two studies have published theoretical applications of using BC‐GN testing in combination with local antibiograms to encourage less use of broad‐spectrum gram‐negative antibiotics . Other studies have shown decreased time to targeted antimicrobial therapy, but these did not include specific data on antibiotic utilization . A study conducted in Japan examining the impact of the gram‐negative and gram‐positive panels for community‐onset bacteremia reported a “common pattern” of de‐escalation among 12 patients with gram‐negative bacteremia from AP to non‐AP antibiotics (10 episodes of E. coli and 2 episodes of K. pneumoniae ) .…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Other studies have shown decreased time to targeted antimicrobial therapy, but these did not include specific data on antibiotic utilization. 2,6,13 A study conducted in Japan examining the impact of the gram-negative and gram-positive panels for community-onset bacteremia reported a "common pattern" of de-escalation among 12 patients with gram-negative bacteremia from AP to non-AP antibiotics (10 episodes of E. coli and 2 episodes of K. pneumoniae). 14 The value of rapid multiplex polymerase chain reaction (PCR) for bacteremia was assessed in a study conducted at Mayo Clinic.…”

Section: Discussionmentioning

confidence: 99%

Rapid identification of gram‐negative bacteremia and impact on antipseudomonal antibiotic consumption with antimicrobial stewardship at a community hospital system

Box

Lee

Ortiz

et al. 2018

J Am Coll Clin Pharm

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Background Rapid identification of gram‐negative bacteremia can improve time to effective antibiotic therapy and antibiotic de‐escalation; however, there are little data that quantify the change in antibiotic utilization. This study evaluates the impact of the Verigene gram‐negative blood culture test (BC‐GN) in combination with an antimicrobial stewardship team (AST) intervention on antipseudomonal (AP) antibiotic utilization in a community hospital system among infections where AP antibiotics are not necessary. Methods This multicenter, pre‐post, quasi‐experimental pilot study was conducted at Scripps Health in San Diego, California. Internal antibiogram data was reviewed, and among the 4 targets of Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, and Proteus species (that lacked resistance genes) detected by the BC‐GN test, antimicrobial sensitivities did not warrant therapy with AP antibiotics. The BC‐GN test was performed at each site where clinical pharmacists notified physicians of results and assisted with antibiotic modifications. The primary end point was AP vs non‐AP antibiotic consumption within the first 5 days of admission. This was measured by days of therapy per patient day (DOT/PD). Secondary end points included hospital and intensive care unit (ICU) length of stay (LOS) and mortality. Results A total of 1051 patients were included; 512 in the pre‐intervention group, and 539 in the intervention group. Compared with the pre‐intervention group, AP antibiotic consumption significantly decreased (0.4 vs 0.2 DOT/PD, P < .0001) and non‐AP antibiotic consumption significantly increased (0.6 vs 0.8 DOT/PD, P < .0001) in the intervention group. Overall median LOS was 5 days vs 5 days (P = .85) and median ICU LOS was 3 days vs 2 days (P = .12), in the pre‐intervention and intervention groups, respectively. Mortality was similar between groups (7.0% vs 5.2% in the pre‐intervention and intervention groups, P = .21). Conclusion Rapid identification of gram‐negative bacteremia with AST intervention decreased AP antibiotic consumption among infections caused by pathogens where AP coverage is not needed.

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Rapid Analytical Methods to Identify Antibiotic‐Resistant Bacteria

Sutherland

Rafii

Lay

et al. 2019

Antibiotic Drug Resistance

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Rapid detection of Gram-negative bacteria and their drug resistance genes from positive blood cultures using an automated microarray assay

Cited by 16 publications

References 36 publications

Clinical Impact of Laboratory Implementation of Verigene BC-GN Microarray-Based Assay for Detection of Gram-Negative Bacteria in Positive Blood Cultures

Clinical Impact of Laboratory Implementation of Verigene BC-GN Microarray-Based Assay for Detection of Gram-Negative Bacteria in Positive Blood Cultures

Rapid identification of gram‐negative bacteremia and impact on antipseudomonal antibiotic consumption with antimicrobial stewardship at a community hospital system

Rapid Analytical Methods to Identify Antibiotic‐Resistant Bacteria

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