The impact of a rapid molecular identification test on positive blood cultures from critically ill with bacteremia: A pre-post intervention study

Abstract

ObjectivesBloodstream infections in critically ill require a speeded-up microbiological diagnosis to improve clinical outcomes. In this pre-post intervention study, we evaluated how a molecular identification test directly performed on positive blood cultures of critically ill improves patient’s therapeutic management.MethodsAll adult patients staying at the intensive care unit (ICU) at the time of positive blood culture detection were study-eligible. In the 8-month pre-intervention period (P0), standard positive blood culture management was performed. In the 10-month intervention period (P1), a BioFire® FilmArray® blood culture identification (FA-BCID) test (bioMérieux) was additionally performed 24/7 at detection. The evaluated clinical outcome was time to optimal antimicrobial treatment of the bloodstream infection. FA-BCID microbiological test performances were also analysed.Results163 positive blood culture episodes were allocated to P0 and 166 to P1. After the withdrawal of episodes in accordance with defined exclusion criteria, outcome analysis was performed on 110 bloodstream infections both in P0 and P1. Time to optimal antimicrobial treatment in P0 was 14h41 compared to 4h39 in P1. FA-BCID test results led to a treatment adjustment in 35/110 (31.8%) P1 episodes including 26 where the adjustment was the optimal antimicrobial treatment. FA-BCID testing identified 96.2% of the on-panel microorganisms thereby covering 85.2% of our ICU-strain epidemiology. Time to identification with FA-BCID testing was calculated at 1h35. Resistance detection was in complete concordance with routine results. Considering 150 FA-BCID tests were initially performed in P1, 4,3 tests were required to have 1 test leading to an improved therapeutic outcome.ConclusionsFA-BCID testing drastically reduced time to optimal antimicrobial treatment in critically ill with bloodstream infections.

Clinical utility of the BioFire FilmArray Blood Culture Identification panel in the adjustment of empiric antimicrobial therapy in the critically ill septic patient

“…Subsequent conventional culture methods yielded a carbapenemase producing K. pneumoniae in this patient. A similar impact on antimicrobial prescription practices has also been demonstrated in other studies [17,[25][26][27][28]. A recent study conducted by Verroken et al (2019) found a similar impact to the present study, with 31.8% of 110 patients undergoing antimicrobial adjustment in response to BioFire FilmArray BCID results [26].…”

“…A similar impact on antimicrobial prescription practices has also been demonstrated in other studies [17,[25][26][27][28]. A recent study conducted by Verroken et al (2019) found a similar impact to the present study, with 31.8% of 110 patients undergoing antimicrobial adjustment in response to BioFire FilmArray BCID results [26]. Most cases involved initiation of appropriate antimicrobial agents, followed by de-escalation and broadening of antimicrobial cover [26].…”

Scanning Electron Microscope: A New Potential Tool to Replace Gram Staining for Microbe Identification in Blood Cultures

“…We have already developed other applications for these SEMs in the rapid detection of respiratory viruses [31], rapid antibiotic susceptibility testing of bacteria [32], detection of bacteria in endocarditic cardiac valve vegetations [33], and identification of several parasites. These various uses of SEM will shift the paradigm of the early diagnosis of infectious diseases, especially in critical cases that have a direct effect on the management of bloodstream infections, the treatment choice, and the patients' prognosis [15,34,35].…”

“…[11][12][13]. Within the last decade, insufficient identifications were switched to culture and eventually relied on other high accuracy methods for microbe identification in blood cultures such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI TOF/MS) [14], molecular biology [15][16][17], multiplex PCR assays, specific hybridization assays, or microarrays [18][19][20][21]. Nevertheless, none of these methods, even though some of them are more costly, present a turn-around time that allows for rapid preliminary identification from the blood culture in the way Gram staining does.…”

New Microbiological Techniques for the Diagnosis of Bacterial Infections and Sepsis in ICU Including Point of Care

“…The BioFire FilmArray BC identification panel (BCID, bioMérieux) is a multiplex PCR which detects 24 pathogens and 3 resistance genes from positive cultures with good analytical performance [ 51 , 52 ]. In a study on ICU patients with culture-confirmed sepsis, this test reduced the time to optimal treatment compared to standard BC [ 53 ] and a role in diagnosing ventilator-associated pneumonia has also been suggested [ 54 ]. A new version of this test has been recently released (BioFire BCID2) with a broader panel including 43 targets, although clinical evaluation studies are awaited.…”