Clinical Impact of Rapid Species Identification From Positive Blood Cultures With Same-day Phenotypic Antimicrobial Susceptibility Testing on the Management and Outcome of Bloodstream Infections

Ehren, Kathrin; Meißner, Anna-Katharina; Jazmati, Nathalie; Wille, Julia; Jung, Norma; Vehreschild, Jörg Janne; Hellmich, Martin; Seifert, Harald

doi:10.1093/cid/ciz406

Cited by 39 publications

(49 citation statements)

References 32 publications

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“…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 ).…”

Section: Discussionsupporting

confidence: 82%

“…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/…”

Section: Discussionmentioning

confidence: 67%

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

Sheth

Miller

Prouse

et al. 2020

Antimicrob Agents Chemother

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Background: Bloodstream infections (BSI) are associated with increased morbidity and mortality, especially when caused by gram-negative or fungal pathogens. The objective of this study was to assess the impact of fast ID/AST with the Accelerate Pheno ™ system (AXDX) from May 2018 to December 2018 on antibiotic therapy and patient outcomes. Methods: A pre-post quasi-experimental study of 200 patients (100 pre-AXDX implementation and 100 post-AXDX implementation) was conducted. The primary endpoints measured were time to first antibiotic intervention, time to most targeted antibiotic therapy, and 14-day hospital mortality. Secondary endpoints included hospital and intensive care unit (ICU) length of stay (LOS), antibiotic intensity score at 96 hours, and 30-day readmission rates. Results: Of 100 patients with gram-negative bacteremia or candidemia in each cohort, 84 in the pre-implementation group and 89 in the AXDX group met all inclusion criteria. The AXDX group had a decreased time to first antibiotic intervention (26.3 vs 8.0 p=0.003), hours to most targeted therapy (14.4 vs 9, p=0.03), hospital LOS (6 vs 8, p=0.002), and average antibiotic intensity score at 96 hours (16 vs 12, p=0.002). Both groups had a comparable 14-day mortality (0% vs 3.6%, p = 0.11). Conclusion: In this analysis of patients with gram-negative bacteremia or candidemia, fast ID/AST implementation was associated with decreased hospital LOS, decreased use of broad-spectrum antibiotics, shortened time to targeted therapy, and an improved utilization of antibiotics within the first 96 hours of therapy.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 67%

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

Sheth

Miller

Prouse

et al. 2020

Antimicrob Agents Chemother

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“…Real-world impact on patient outcomes has been examined in small studies that included Gram-negative bacteremia and showed improved time to optimal antimicrobial therapy but no change in clinical outcomes or antibiotic consumption (24)(25)(26). 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.…”

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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“…However, whether this rapid turnaround time (TAT) translates into more favorable clinical outcomes remains to be determined. 46 , 47 …”

Section: Rapid Direct Phenotypic Antimicrobial Susceptibility Testimentioning

confidence: 99%

Modern Blood Culture

Gonzalez

Chao

Pettengill

2020

Clinics in Laboratory Medicine

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The optimal care of septic patients depends on the successful recovery of clinically relevant microorganisms from blood cultures and the timely reporting of organism identification and antimicrobial susceptibility testing (AST) results. Many preanalytic factors play a critical role in culturing microorganisms, and advancements in blood culture instrument technology have reduced the time to positive results. Additionally, rapid organism identification and AST results directly from positive blood culture broth via new methods help to further shorten the time from empiric to targeted treatment. This article summarizes the current state of blood culture methods, including preanalytic, analytical, and postanalytic factors that are available to clinical microbiology laboratories.

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Clinical Impact of Rapid Species Identification From Positive Blood Cultures With Same-day Phenotypic Antimicrobial Susceptibility Testing on the Management and Outcome of Bloodstream Infections

Cited by 39 publications

References 32 publications

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

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

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

Modern Blood Culture

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