Clinical Impact of Accelerate Pheno Rapid Blood Culture Detection System in Bacteremic Patients

Abstract

Background Accelerate Pheno blood culture detection system (AXDX) provides identification (ID) and antimicrobial susceptibility testing (AST) results within 8h of blood culture growth. Limited data exists regarding its clinical impact. Other rapid platforms coupled with antimicrobial stewardship program (ASP) real-time notification (RTN) have shown improved length of stay (LOS) in bacteremia Methods A single-center, quasi-experimental study of adult bacteremic inpatients before/after AXDX implementation was conducted comparing clinical outcomes from 1 historical and 2 intervention cohorts (AXDX and AXDX+RTN). Primary outcome was LOS. Results Of 830 bacteremic episodes, 188 (77%) of 245 historical and 308 (155 AXDX, 153 AXDX+RTN; 65%) of 585 intervention episodes were included. Median LOS was shorter with AXDX (6.3d) and AXDX+RTN (6.7d) compared to historical (8.1d; P=0.001). Achievement of optimal therapy (AOT) was more frequent (93.6% and 95.4%) and median time to optimal therapy (TTOT) was faster (1.3d and 1.4d) in AXDX and AXDX+RTN compared to historical (84.6%, P≤0.001 and 2.4d; P≤0.001) respectively. Median antimicrobial days of therapy (DOT) was shorter in both intervention arms compared to historical (6d each vs 7d; P=0.011). Median LOS benefit was most pronounced in patients with coagulase negative Staphylococcus bacteremia (5.5d and 4.5d vs 7.2d; P=0.003) in AXDX, AXDX+RTN, and historical cohorts respectively. Conclusions LOS, AOT, TTOT, and total DOT significantly improved after AXDX implementation. Addition of RTN did not show further improvement over AXDX and an already active ASP. These results suggest AXDX can be integrated into healthcare systems with an active ASP even without the resources to include RTN.

Implementation of a Rapid Phenotypic Susceptibility Platform for Gram-Negative Bloodstream Infections With Paired Antimicrobial Stewardship Intervention: Is the Juice Worth the Squeeze?

“…This led to a statistically significant decrease in broad-spectrum DOTs and an increase in narrow-spectrum beta-lactam usage during the observed time period. Though earlier de-escalation of broad-spectrum therapies has been associated with improved clinical outcomes for CDI [ 26 , 27 ] and LOS [ 12 ], these were not observed in our study. Similar to other recent studies of the Accelerate Pheno TM system [ 11–13 ] we did not observe any difference in other clinical outcomes.…”

“…Other studies to date have assessed time to preferred therapy as defined by expert review and limited their evaluation to on-panel organisms. Another study noted a 43-hour decrease in time to optimal therapy for GNB with a longer historical comparison [ 12 ].…”

“…The Accelerate Pheno TM system (Accelerate Diagnostics, Tucson, AZ) is a novel RDT which uses fluorescence in-situ hybridization for rapid species identification (ID) and morphokinetic bacterial analysis for phenotypic antimicrobial susceptibility testing (AST) within 7 hours of a positive blood culture result [ 10 ]. Recent studies have shown improved time to first antimicrobial change [ 11 ] and optimal antimicrobial therapy [ 12 , 13 ] when employing the Accelerate Pheno TM system in combination with an ASP intervention for GNB BSI. However, outside of improvement in length of stay (LOS) in one study [ 12 ], little change in clinical outcomes has been observed.…”

“…Recent studies have shown improved time to first antimicrobial change [ 11 ] and optimal antimicrobial therapy [ 12 , 13 ] when employing the Accelerate Pheno TM system in combination with an ASP intervention for GNB BSI. However, outside of improvement in length of stay (LOS) in one study [ 12 ], little change in clinical outcomes has been observed. Though previous studies show favorable concordance with conventional methods [ 10 , 14 ], there has been limited evaluation of the potential for harm when discordance does occur.…”

Management of Gram-Negative Bloodstream Infections in the Era of Rapid Diagnostic Testing: Impact With and Without Antibiotic Stewardship

“…Additionally, the differences in detection could be secondary to differences in analytic techniques and need to be further investigated [ 25 , 46 ]. The application of RDTs that provide phenotypic susceptibility information, either in place of or in addition to genetic resistance testing, although beyond the scope of this paper, is an area of ongoing research [ 47 ].…”