Rapid Testing Using the Verigene Gram-Negative Blood Culture Nucleic Acid Test in Combination with Antimicrobial Stewardship Intervention against Gram-Negative Bacteremia

Bork, Jacqueline T.; Leekha, Surbhi; Heil, Emily L.; Zhao, Long; R, Badamas; Johnson, J. Kristie

doi:10.1128/aac.04259-14

Cited by 77 publications

(69 citation statements)

References 21 publications

(22 reference statements)

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“…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). However, this isolate was unavailable for further testing in this retrospective analysis.…”

Section: Discussionsupporting

confidence: 77%

“…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). From a laboratory perspective, it was encouraging that our data demonstrated a positive clinical impact based on the BC-GN test with the antimicrobial stewardship practices that were already in place.…”

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: 77%

Section: Discussionmentioning

confidence: 99%

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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“…Bork and colleagues (13) predicted an 18.3-h reduction in the time to optimal therapy and a 3.7-h reduction in the time to effective antimicrobial therapy when utilizing a simulated model based on BC-GN reporting and ASP intervention (13). Similar to this simulation, our study was able to demonstrate a reduction in the time to optimal therapy.…”

supporting

confidence: 76%

“…Molecular diagnostic assays can produce results faster than traditional identification and susceptibility testing methods and may help decrease the time to appropriate antimicrobial therapy (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The Verigene Gram-negative blood culture (BC-GN) assay (Nanosphere, Inc., Northbrook, IL) is a qualitative in vitro diagnostic test for the rapid detection and identification of select Gram-negative bacteria and resistance markers (17).…”

mentioning

confidence: 99%

A Stewardship Approach To Optimize Antimicrobial Therapy through Use of a Rapid Microarray Assay on Blood Cultures Positive for Gram-Negative Bacteria

et al. 2015

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A Gram-negative (GN) blood culture microarray assay with an antimicrobial stewardship program (ASP) intervention was evaluated in 126 patients with GN bacteremia. The median time to optimal therapy was shorter in the postintervention group than in the preintervention group (49.3 h versus 38.5 h, respectively; P ‫؍‬ 0.0199). ASP can utilize microarray technology to decrease the time to optimal antimicrobial therapy. The treatment of Gram-negative bloodstream infections (GN-BSI) is particularly complicated due to high rates of resistance from multiple resistance mechanisms, including the production of extended-spectrum ␤-lactamase (ESBL) and carbapenemase enzymes, leaving limited treatment options (1, 2). Molecular diagnostic assays can produce results faster than traditional identification and susceptibility testing methods and may help decrease the time to appropriate antimicrobial therapy (3-18). The Verigene Gram-negative blood culture (BC-GN) assay (Nanosphere, Inc., Northbrook, IL) is a qualitative in vitro diagnostic test for the rapid detection and identification of select Gram-negative bacteria and resistance markers (17). The purpose of this study was to evaluate the impact of an antimicrobial stewardship program (ASP) on the time to optimal antimicrobial therapy, utilizing rapid organism and resistance identification via the BC-GN test, on patients with GN-BSI.This was a retrospective, quasiexperimental, and preintervention/postintervention study conducted at University of Florida Health and was approved by the University of Florida Health Science Center Jacksonville institutional review board. All inpatient adults with documented GN-BSI between 15 September 2013 and 15 February 2014 (pre-BC-GN period) and between 15 September 2014 and 15 February 2015 (post-BC-GN period) were evaluated for inclusion. Exclusion criteria included polymicrobial BSI, documented infections caused by organisms not identified by the BC-GN test, incarcerated patients, involvement with other investigational protocols, or death prior to culture results. During the pre-BC-GN period, the ASP reviewed the prescribed antimicrobial agents and provided pharmacotherapeutic recommendations to prescribers as microbiology information became available during normal business hours. In the postintervention period, the BC-GN test was performed according to the manufacturer's specifications (17), and the results were reported in a similar fashion as done previously (10). Microbiology paged the ASP 24 h per day, 7 days per week with BC-GN test results. The ASP contacted physicians during normal business hours with pharmacotherapeutic recommendations based on BC-GN test results. All BC-GN test results were confirmed by conventional microbiological methods, including rapid spot tests (oxidase and indole) and the Vitek 2 GN identification and GN-73 susceptibility cards (bioMérieux, Durham, NC).After retrospective identification of patients with GN-BSI, the electronic health record (EHR) was used to identify patients for inclusion and exclusion cri...

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“…Rapid identifi cation of GN bacteremia and key susceptibility markers can lead to many benefi ts, such as earlier deescalation of empiric therapy and switch to appropriate targeted antimicrobials that can lead to better patient outcomes, decreased length of hospital stay, and decreased overall hospital costs (9)(10)(11)(12). Th e Verigene BC-GN assay has two major advantages favoring its routine use: a random-access format with very limited handson time and the ability to rapidly provide clinically actionable therapeutic information to physicians.…”

Section: Discussionmentioning

confidence: 99%

Clinical Uptake of Antimicrobial Stewardship Recommendations Following Nanosphere Verigene Blood Culture Gram-Negative Reporting

Belknap¹,

Grosser²,

Hale³

et al. 2017

Baylor University Medical Center Proceedings

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Rapid Testing Using the Verigene Gram-Negative Blood Culture Nucleic Acid Test in Combination with Antimicrobial Stewardship Intervention against Gram-Negative Bacteremia

Cited by 77 publications

References 21 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

A Stewardship Approach To Optimize Antimicrobial Therapy through Use of a Rapid Microarray Assay on Blood Cultures Positive for Gram-Negative Bacteria

Clinical Uptake of Antimicrobial Stewardship Recommendations Following Nanosphere Verigene Blood Culture Gram-Negative Reporting

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