Susceptibility Provision Enhances Effective De-escalation (SPEED): utilizing rapid phenotypic susceptibility testing in Gram-negative bloodstream infections and its potential clinical impact

Schneider, Jack G; Wood, James B.; Schmitt, Bryan H.; Emery, Christopher L.; Davis, Thomas E.; Smith, Nathan W.; Blevins, Sarah; Hiles, Jon; Desai, Armisha; Wrin, Justin; Bocian, Brittany; Manaloor, John J.

doi:10.1093/jac/dky531

Cited by 18 publications

(18 citation statements)

References 34 publications

(45 reference statements)

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“…Clinical samples from patients with monomicrobial gramnegative bacteremia were tested and compared between the Accelerate Pheno System and standard of care methods including VERIGENE and Bruker MALDI Biotyper systems for ID and the VITEK 2 system for AST. 102 ID mean time was 21 hours for MALDI-TOF MS, 4.4 hours for VERIGENE, and 3.7 hours for the Accelerate Pheno System. AST mean time was 35 hours for VITEK 2 and 9.0 hours for the Accelerate Pheno System.…”

Section: Evidence In Support Of the Use Of Rdts To Optimize Antibiotimentioning

confidence: 99%

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Guillamet

Burnham

Kollef

2019

Semin Respir Crit Care Med

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Antibiotic resistance is recognized as a key determinant of outcome in patients with serious infections influencing empiric antibiotic practices especially for critically ill patients. Within the intensive care unit (ICU), nosocomial infections and increasingly community-onset infections are caused by multidrug-resistant bacteria. Escalating rates of antibiotic resistance adds substantially to the morbidity, mortality, and cost related to infections treated in the ICU. Both gram-positive organisms, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, and gram-negative bacteria, including Pseudomonas aeruginosa, Acinetobacter species, carbapenem-resistant Enterobacteriaceae, and extended spectrum β-lactamase producing organisms, are urgent threats. The rising rates of antimicrobial resistance have resulted in routine empiric administration of broad-spectrum antibiotics by clinicians to critically ill patients even when bacterial infection is microbiologically absent. Moreover, new broad-spectrum antibiotics are a challenge to use effectively while avoiding emergence of further resistance. Use of rapid diagnostic technologies (RDTs) will likely provide an important methodology for achieving this important balance. There is an urgent need for integrating the administration of new and existing antibiotics with RDTs in a way that is safe, cost-effective, applicable in all countries, and sustainable.

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Section: Evidence In Support Of the Use Of Rdts To Optimize Antibiotimentioning

confidence: 99%

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Guillamet

Burnham

Kollef

2019

Semin Respir Crit Care Med

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“…Selection of positive blood cultures from the daytime shift only and a dedicated team of investigators with full ASP intervention may explain shorter intervals for antibiotic change. Other published studies have considered the theoretical benefit of rapid testing with the Accelerate Pheno system and projected it to be beneficial (8,(27)(28)(29)(30); however, this may not reflect real-world challenges in implementation of rapid AST strategy.…”

Section: Discussionmentioning

confidence: 99%

Impact of Rapid Antimicrobial Susceptibility Testing in Gram-Negative Rod Bacteremia: a Quasi-experimental Study

et al. 2020

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Background: Clinical justification for rapid antimicrobial susceptibility testing (AST) in Gram-negative rod (GNR) bacteremia is compelling; however, evidence supporting its value is sparse. We investigated the impact of rapid AST on clinical and antimicrobial stewardship outcomes in real-world practice. Methods: We performed a before and after quasi-experimental study from February 2018 to July 2019 at a tertiary hospital of the 24-hour/day, 7-day/week implementation of the direct VITEK®2 AST method from positive blood culture broth for GNR bacteremia with electronic isolate-specific de-escalation comments, and daytime antibiotic stewardship program (ASP) intervention. The primary outcome was time to appropriate antibiotic escalation or de-escalation, and secondary outcomes included time to oral antibiotic step-down, hospital length-of-stay (LOS), all-cause 30-day mortality, 7-day incidence of acute kidney injury (AKI) and 30-day incidence of C. difficile infection (CDI). Results: A total of 671 GNR isolates were included from 643 adult patients. Among patients for whom antibiotic change occurred after rapid AST result, rapid AST was associated with a trend in decreased time to escalation or de-escalation (hazard ratio 1.22, 95% CI 0.99-1.51; p=0.06), with median times of 52.3 vs 42.2 hours. Secondary outcomes were similar in both groups including median time to oral antibiotic step-down, LOS, all-cause mortality, and incidence of AKI and CDI. Conclusion: Rapid AST led to improved stewardship measures but did not impact clinical patient outcomes. These results highlight that multiple variables in addition to timing of AST result contribute to clinical outcome and that further intervention may be required to clinically justify rapid AST implementation.

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“…The use of rapid phenotypic susceptibility techniques have demonstrated their interest in an optimized antimicrobial treatment (Schneider et al, 2019 ). Globally, our study shows excellent PPV (both 100%) but poor NPV (46.7 and 52.2%) for the BL-RED TM and β-LACTA TM tests, respectively.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Two Methods for the Detection of Third Generation Cephalosporins Resistant Enterobacterales Directly From Positive Blood Cultures

Durand

Boudet

Lavigne

et al. 2020

Front. Cell. Infect. Microbiol.

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Due to the importance of a rapid determination of patients infected by multidrug resistant bacteria, we evaluated two rapid diagnostic tests for the detection of third-generation cephalosporins (3GC)-resistant Enterobacterales directly from positive blood cultures within 1 h: BL-RED TM (electrochemical method) and β-LACTA TM test (chromogenic method). A panel of 150 clinical strains characterized for their resistance profiles (e.g., penicillinases, extended-spectrum beta-lactamases (ESBLs), overproduction of cephalosporinase, carbapenemases, impermeability) was tested. Approximately 100 CFU of each isolate was spiked into sterile blood culture bottles and incubated in a BD BACTEC TM FX automated system (Becton Dickinson, USA). Positive blood cultures were examined to parallel testing using the BL-RED TM and β-LACTA TM tests and conventional susceptibility method (disc diffusion following EUCAST recommendations). For all phenotypes combined, the sensitivity, specificity, positive predictive value, and negative predictive value in the detection of 3GC resistance were, respectively (i) with BL-RED TM : 45.7, 100, 100, and 54.2% and (ii) with β-LACTA TM test: 52.2, 100, 100, and 56.9%. The positivity of tests allows to adapt antibiotic treatment whereas the negative result requires other tests. Moreover, these tests detect most Ambler class A-producing Enterobacterales (KPC, ESBL, extended-spectrum OXY) with sensitivities and specificities of 87.5 and 99% for BL-RED TM , respectively and both 100% for β-LACTA TM test (47/47 isolates). These two rapid tests failed to detect AmpC overexpressed (sensitivities of 2.7% for BL-RED TM and 0% for β-LACTA TM test) and Ambler class B-producing Enterobacterales (sensitivities of 40% for both tests) notably strains without ESBLs associated (sensitivities of 0% for both tests). BL-RED TM and β-LACTA TM tests are easy-to-use and mainly attractive when a positive result is obtained notably to detect most of the Ambler class A-producing Enterobacterales in <1 h after the positivity of the blood culture, allowing a rapid adaptation of the antibiotic therapy in patients.

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Susceptibility Provision Enhances Effective De-escalation (SPEED): utilizing rapid phenotypic susceptibility testing in Gram-negative bloodstream infections and its potential clinical impact

Cited by 18 publications

References 34 publications

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Impact of Rapid Antimicrobial Susceptibility Testing in Gram-Negative Rod Bacteremia: a Quasi-experimental Study

Evaluation of Two Methods for the Detection of Third Generation Cephalosporins Resistant Enterobacterales Directly From Positive Blood Cultures

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