The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial

Abstract

Background Appropriate use of antimicrobials is essential to improve outcomes in sepsis. The aim of this study was to determine whether the use of a rapid molecular blood test—Septi Fast (SF) reduces the antibiotic consumption through early de-escalation in patients with nosocomial sepsis compared with conventional blood cultures (BCs). Methods This was a prospective, randomized, superiority, controlled trial conducted at Sao Paulo Heart Institute in the period October 2012–May 2016. Adult patients admitted to the hospital for at least 48 h with a diagnosis of nosocomial sepsis underwent microorganism identification by both SF test and BCs. Patients randomized into the intervention group received antibiotic therapy adjustment according to the results of SF. Patients randomized into the control group received standard antibiotic adjustment according to the results of BCs. The primary endpoint was antimicrobial consumption during the first 14 days after randomization. Results A total of 200 patients were included (100 in each group). The intention to treat analysis found no significant differences in median antibiotic consumption. In the subgroup of patients with positive SF and blood cultures (19 and 25 respectively), we found a statistically significant reduction in the median antimicrobial consumption which was 1429 (1071–2000) days of therapy (DOT)/1000 patients-day in the intervention group and 1889 (1357–2563) DOT/1000 patients-day in the control group ( p = 0.017), in the median time of antimicrobial de-escalation (8 versus 54 h— p < 0.001), in the duration of antimicrobial therapy ( p = 0.039) and in anti-gram-positive antimicrobial costs ( p = 0.002). Microorganism identification was possible in 24.5% of patients (45/184) by SF and 21.2% (39/184) by BC ( p = 0.45). Conclusion This randomized clinical trial showed that the use of a rapid molecular-based pathogen identification test does not reduce the median antibiotic consumption in nosocomial sepsis. However, in patients with positive microbiological tests, the use of Septi Fast reduced antimicrobial consumption through early de-escalation compared to conventional blood cultures. These results were driven by a reduction in the consumption of antimicrobials used for Gram-positive bacteria. Trial registration The trial was registered at ClinicalTrials.gov ( NCT 01450358 ) on 12th October 2011 Electronic supplementary material The online version of this article (10.1186/s40560-019-0391-3) contains supplementary material, which is available to authorized users.

Impact of an Antimicrobial Stewardship Program Intervention Associated with the Rapid Identification of Microorganisms by MALDI-TOF and Detection of Resistance Genes in ICU Patients with Gram-Negative Bacteremia

“…During this period, we observed that the microbiology laboratory, despite having the MALDI-TOF, waited the 24-h incubation period for bacteria identification. Therefore, after identifying the species directly from bottles of positive blood culture, we started to perform this technique during the intervention period, in addition to a rapid communication to the prescribing physician and the detection of resistance genes [ 11 , 12 , 18 ].…”

“…Our results from rapid molecular tests performed on blood cultures flagged positive during the intervention period showed a high prevalence of microbiological isolates producers of ESBL (68.6%), oxacilinases (41.2%), and KPC (27.4%). Knowledge of the resistance mechanism before the susceptibility test is a very useful point-of-care and highly recommended tool that certainly contributes to the de-escalation and adjustment of the antimicrobial regimen [ 3 , 18 , 19 , 25 ]. It remains to be seen what the long-term impact will be of reducing bacterial resistance.…”

New evidence for managing Gram-negative bloodstream infections

“…In another study, use of LightCycler SeptiFast (Roche Diagnostics, Switzerland) has led to a significant decrease in time to de-escalation, and reduction in median antibiotic consumption compared to BC-based approach [12 ▪▪ ]. However, no impact on in-hospital mortality was demonstrated with the use of the assay [12 ▪▪ ,15].…”

Current opinion in management of septic shock due to Gram-negative bacteria

“…Nucleic acid amplification tests (NAAT) identify pathogens in about 6 h directly after the blood was drawn. Whenever tested in the clinical setting, its performance remains, however, insufficient for prime clinical use [16 ▪ ,17–19]. The T2 magnetic resonance (T2MR) is a newer fully automated method that detects a range of pathogens directly on whole blood.…”