Real-World Impact of the Accelerate PhenoTest BC Kit on Patients With Bloodstream Infections in the Improving Outcomes and Antimicrobial Stewardship Study: A Quasiexperimental Multicenter Study

Abstract

Background Bloodstream infections (BSI) are a leading cause of morbidity and mortality in hospitalized patients. The IOAS (Improving Outcomes and Antimicrobial Stewardship) study seeks to evaluate the impact of the Accelerate PhenoTest® BC Kit (AXDX) on antimicrobial use and clinical outcomes in BSIs. Methods This multicenter, quasi-experimental study compared clinical and antimicrobial stewardship metrics, prior to and after implementation of AXDX testing, to evaluate the impact this technology has on patients with BSI. Laboratory and clinical data from hospitalized patients with BSI (excluding contaminants) were compared between two arms, one that underwent testing on AXDX (post-AXDX) and one that underwent alternative organism identification and susceptibility testing (pre-AXDX). The primary outcomes were time to optimal therapy (TTOT) within 96 hours of blood culture positivity and 30-day mortality. Results A total of 854 patients with BSI (435 pre-AXDX, 419 post-AXDX) were included. Median TTOT was 17.2 hours shorter in the post-AXDX arm (23.7 hours) compared to the pre-AXDX arm (40.9 hours; P<0.0001). Compared with pre-AXDX, median time to first antimicrobial modification (24.2 versus 13.9 hours; P<0.0001) and first antimicrobial de-escalation (36.0 versus 27.2 hours; P=0.0004) were shorter in the post-AXDX arm. Mortality (8.7% pre-AXDX versus 6.0% post-AXDX), length of stay (7.0 pre-AXDX versus 6.5 days post-AXDX), and adverse drug events were not significantly different between arms. Length of stay was shorter in the post-AXDX arm (5.4 versus 6.4 days; P=0.03) among patients with Gram-negative bacteremia. Conclusions For BSIs, use of AXDX was associated with significant decreases in TTOT, first antimicrobial modification, and time to antimicrobial de-escalation.

Impact on time to active antimicrobial therapy with 24-hour pharmacist review of Accelerate Pheno BC Kit results

“…As was the experience at our institution, previous studies have demonstrated that implementation of the Accelerate Pheno system improves time to optimal antimicrobial therapy, particularly when paired with ASP review. [6][7][8] However, an opportunity remained to ensure that patients were at least on an active antimicrobial based on the results of the Accelerate Pheno system in the hours that the ASP team was not in house to review results in real time.…”

“…5 Our clinical microbiology laboratory implemented Accelerate Pheno in September 2018 with real-time intervention by the ASP during standard workday hours, leading to decreased time to optimal therapy. 6,7 We identified an opportunity to further improve patient care by reducing delays in initiation of active antimicrobial therapy outside regular ASP work hours. In this study, we evaluated the impact of incorporating 24-hour unit-based pharmacist review of rapid blood-culture results.…”

Clinical impact of the Accelerate PhenoTest® BC system on patients with Gram-negative bacteremia and high risk of antimicrobial resistance: A prospective before-after implementation study

“…A signi cant shortening of TAT times was previously shown after AXDX implementation (2,3,(15)(16)(17)(18)(19)(20)(21)4,5,(9)(10)(11)(12)(13)(14). In studies assessing AXDX clinical impact, the time to identi cation and AST was shorter than the SOC by 11.3-40.7 hours (12)(13)(14)(18)(19)(20)(21).…”

“…Sheth et al showed a 1-day shorter LOS and a shorter duration of broad spectrum treatment (22). Bhalodi et al reported a 1-day shorter LOS only for patients with GNB (14). The most striking clinical impact was reported by Babowicz et al with 85% lower risk of death after implementing AXDX (18).…”

“…The Accelerate PhenoTest® BC system (AXDX, Accelerate Diagnostics, Tucson, AZ) provides a shorter turn-around time (TAT) for identi cation and AST (to approximately 2 and 7 hours, respectively) by using morphokinetic cellular analysis. Previous studies have evaluated the analytical performance of AXDX (2)(3)(4)(5)(6)(7)(8)(9)(10) and the clinical impact of its implementation for bacteremias (11)(12)(13)(14), and speci cally for GNB (15)(16)(17)(18)(19)(20)(21)(22).…”