1758. Impact of Accelerate Pheno™ Rapid Blood Culture Detection System on Laboratory and Clinical Outcomes in Bacteremic Patients

Abstract

BackgroundMolecular-based automated systems for the rapid diagnosis of bacterial infections have potential to improve patient care. The Accelerate Pheno™ blood culture detection system (ACCEL) is an FDA approved platform that allows for identification (ID) and antimicrobial susceptibility testing (AST) 8 hours following growth in routine culture.MethodsThis is a single-center retrospective chart review of bacteremic adult inpatients before and after implementation of ACCEL. Laboratory and clinical data were collected February–March 2018 (intervention) and compared with a January–April 2017 historical cohort (standard of care). Standard of care ID and AST were performed using VITEK® MS (MALDI-TOF MS) and VITEK®2, respectively. An active antimicrobial stewardship program was in place during both study periods. Patients with polymicrobial cultures, off-panel isolates, previous positive culture, or who were discharged prior to final AST report were excluded. Primary outcome was length of stay (LOS). Secondary outcomes were inpatient antibiotic duration of therapy (DOT) and time to optimal therapy (TTOT). Nonparametric unadjusted analyses were performed due to non-normal distributions. Statistics were performed using SAS 9.4.ResultsOf the 143 positive cultures performed on ACCEL during intervention, 118 (83%) were identified as on-panel organisms. Seventy-five (64%) of these 118 cultures and 79 (70%) of 113 reviewed standard of care cultures met inclusion criteria. Patient comorbidities (P = NS), MEWS severity score (P = 0.10), source of bacteremia (P = NS), and pathogen detected (P = 0.30) were similar between cohorts. Time from collection to ID (28.2 ± 12.7 hours vs. 53.8 ± 20.9 hours; P < 0.001) and AST (31.9 ± 11 hours vs. 71.8 ± 20 hours; P < 0.001) were shorter in the intervention arm.Clinical OutcomesStandard of Care (Mean ± SD) N = 79Intervention (Mean ± SD), N = 75 P-valueLOS (days)12.1 (11.9)9.1 (7.6)0.03TTOT (hours)73.5 (50.2)37.5 (32.7)<0.001Total antibiotic DOT (days)9.0 (7.5)7.0 (4.6)0.05Meropenem DOT (days)6.6 (3.7)3.7 (2.1)0.03ConclusionCompared with standard of care, ACCEL shortens laboratory turn-around-time and improves clinical outcomes. The use of this system has resulted in decreased mean antibiotic DOT, TTOT, and LOS. Further studies are needed to verify these findings.Disclosures All authors: No reported disclosures.

Pharmacist-Driven Implementation of Fast Identification and Antimicrobial Susceptibility Testing Improves Outcomes for Patients with Gram-Negative Bacteremia and Candidemia

“…We observed that providers were more willing to de-escalate empirical antimicrobial therapy after final AST (provided by AXDX) as opposed to after ID and resistance gene results alone, primarily due to the possibility of undetected resistance with genotypic testing. This is similar to that for other institutions that have shown time from Gram stain to ID and AST, time to optimal therapy, time to step-down antimicrobial therapy, and length of stay outcomes through AXDX utilization ( 14 , 15 ). This earlier de-escalation of antimicrobial therapy in Enterobacteriaceae bloodstream infections can significantly help decrease Clostridioides difficile infection rates, as recently reported in literature ( 16 ).…”

“…This is similar to other institutions that have shown time from gram stain to ID and AST, time to optimal therapy, time to step-down antimicrobial therapy, and length of stay outcomes through AXDX utilization. [17][18] This earlier de-escalation of antimicrobial therapy in Enterobacteriaceae bloodstream infections can significantly help decrease Clostridioides difficile infection rates as recently reported in literature. 19 on October 29, 2020 by guest http://aac.asm.org/…”

The Present and Future State of Antimicrobial Stewardship and Rapid Diagnostic Testing: Can One Ideally Succeed Without the Other?

“…Additionally, usage of certain antibiotics such as cefepime, aminoglycosides, piperacillin/tazobactam, and vancomycin could have decreased with use of Accelerate Pheno™. In a single-center before-and-after cohort study of actual clinical use, implementation of Accelerate Pheno™ was associated with shorter time to optimal therapy, length of stay, and antibiotic duration of therapy as compared with historical conventional identification (including MALDI/TOF) and antimicrobial susceptibility testing methods [17].…”