Evaluation of rapid polymerase chain reaction-based organism identification of gram-positive cocci for patients with a single positive blood culture

MacVane, Shawn H.; Raux, Brian R.; Smith, Tiffeny T.

doi:10.1007/s10096-019-03574-3

Cited by 8 publications

(10 citation statements)

References 24 publications

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“…Past studies have shown that a robust ASP, that monitors patient management and provides feedback in real time, utilized in combination with rapid PCR testing, significantly reduces unwanted clinical consequences in patients with true bloodstream infections. 17,20,26 The influence of a strong ASP on patient outcomes has also been demonstrated in conjunction with conventional blood-culture methods. 20 However, to obtain maximum benefit, the implementation of new technology should be accompanied by decision support tools and interpretive guidance.…”

Section: Discussionmentioning

confidence: 99%

“…16 However, they reported that the duration of antibiotic therapy did not significantly differ between the 2 groups. When comparing periods before and after PCR was implemented, MacVane et al 17 found the median length of hospital stay to be 8 days versus 7 days ( P = .75) and antibiotic therapy duration with vancomycin to be 1.3 versus 1.7 days ( P = .28) in patients with contaminated blood cultures. 17 Cattoir et al 18 analyzed 154 episodes of contaminated blood cultures and reported that 17% of those in the PCR testing group were given unnecessary antibiotics compared to 10% patients in the conventional testing group (OR, 1.77; 95% CI, 0.62–5.12; P = .237).…”

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confidence: 99%

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Clinical outcomes associated with blood-culture contamination are not affected by utilization of a rapid blood-culture identification system

Khan

Haynatzki

Medcalf

et al. 2023

Infect. Control Hosp. Epidemiol.

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Objective: Contaminated blood cultures result in extended hospital stays and extended durations of antibiotic therapy. Rapid molecular-based blood culture testing can speed positive culture detection and improve clinical outcomes, particularly when combined with an antimicrobial stewardship program. We investigated the impact of a multiplex polymerase chain reaction (PCR) FilmArray Blood Culture Identification (BCID) system on clinical outcomes associated with contaminated blood cultures. Methods: We conducted a retrospective cohort study involving secondary data analysis at a single institution. In this before-and-after study, patients with contaminated blood cultures in the period before PCR BCID was implemented (ie, the pre-PCR period; n = 305) were compared to patients with contaminated blood cultures during the period after PCR BCID was implemented (ie, the post-PCR implementation period; n = 464). The primary exposure was PCR status and the main outcomes of the study were length of hospital stay and days of antibiotic therapy. Results: We did not detect a significant difference in adjusted mean length of hospital stay before (10.8 days; 95% confidence interval [CI], 9.8–11.9) and after (11.2 days; 95% CI, 10.2–12.3) the implementation of the rapid BCID panel in patients with contaminated blood cultures (P = .413). Likewise, adjusted mean days of antibiotic therapy between patients in pre-PCR group (5.1 days; 95% CI, 4.5–5.7) did not significantly differ from patients in post-PCR group (5.3 days; 95% CI, 4.8–5.9; P = .543). Conclusion: The introduction of a rapid PCR-based blood culture identification system did not improve clinical outcomes, such as length of hospital stay and duration of antibiotic therapy, in patients with contaminated blood cultures.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Clinical outcomes associated with blood-culture contamination are not affected by utilization of a rapid blood-culture identification system

Khan

Haynatzki

Medcalf

et al. 2023

Infect. Control Hosp. Epidemiol.

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“…All adult patients with ≥1 blood culture positive for a bacterial organism included on the BCID panel, which features 19 bacterial and three antimicrobial resistance targets, were eligible for inclusion. Exclusion criteria were (i) polymicrobial BSI; (ii) prior blood culture with the same organism within the previous 1 year; (iii) lack of available susceptibility data; and (iv) death within 48 h of BSI 12 . Coagulase‐negative Staphylococcus cases were excluded due to concerns for potential contamination.…”

Section: Methodsmentioning

confidence: 99%

“…Exclusion criteria were (i) polymicrobial BSI; (ii) prior blood culture with the same organism within the previous 1 year; (iii) lack of available susceptibility data; and (iv) death within 48 h of BSI. 12 Coagulase-negative Staphylococcus cases were excluded due to concerns for potential contamination. For patients with multiple BSIs during the study period, only the first BSI episode was analyzed.…”

Section: Study Design and Populationmentioning

confidence: 99%

Examining the clinical impact of rapid multiplex polymerase chain reaction‐based diagnostic testing for bloodstream infections in a national cohort of the Veterans Health Administration

Britt

Khader

et al. 2022

Pharmacotherapy

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Study Objective Bloodstream infections (BSIs) are a significant cause of mortality. Use of a rapid multiplex polymerase chain reaction‐based blood culture identification panel (BCID) may improve antimicrobial utilization and clinical outcomes by shortening the time to appropriate therapy and de‐escalating antibiotics among patients on overly broad‐spectrum empiric therapy. The effect of BCID on clinical outcomes across varying institutional antimicrobial stewardship program (ASP) practices is unclear. This study evaluated clinical outcomes associated with the “real‐world” implementation of BCID in a national health system with varying ASP practices. Design National, multicenter, retrospective, pre–post quasi‐experimental study of hospitalized patients admitted from 2015 to 2020 to VHA facilities, which introduced the BCID for ≥1 year. Setting United States Veterans Health Administration (VHA) hospitals with BCID. Patients Hospitalized VHA patients with ≥1 blood culture positive for bacteria featured on the BCID panel. Intervention Comparison of outcomes between the pre‐ and post‐BCID implementation groups. Measurements Outcomes evaluated included early antimicrobial de‐escalation within 48 h, defined as reduction in antimicrobial spectrum scores, time to appropriate therapy, and 30‐day mortality. Main Results A total of 4138 patients (pre‐BCID, n = 2100; post‐BCID, n = 2038) met the study criteria. Implementation of BCID was associated with significant improvements in early antimicrobial de‐escalation (34.6%: pre‐BCID vs. 38.1%: post‐BCID; p = 0.022), which persisted after adjusting for other covariates (adjusted risk ratio [aRR], 1.11; 95% confidence interval [CI], 1.02–1.20; p = 0.011). Median time to appropriate therapy was shorter in the post‐BCID implementation group relative to the pre‐BCID group (9 h: pre‐BCID vs. 8 h: post‐BCID, respectively, p = 0.005), and a greater percentage of patients received early appropriate antimicrobial therapy within 48 h in the post‐BCID implementation group (91.7%: pre‐BCID vs. 93.8%: post‐BCID; p = 0.008). In the multivariable regression analysis, BCID implementation was significantly associated with a higher likelihood of appropriate therapy within 48 h (aRR, 1.02; 95% CI, 1.01–1.08; p = 0.020). There was no difference in 30‐day mortality between groups overall (12.6% pre‐BCID vs. 11.2% post‐BCID; p = 0.211). Conclusions In a “real‐world” clinical setting, the implementation of BCID was associated with clinical improvements in antimicrobial utilization. The BCID platform may serve as a useful adjunct for BSI management in facilities with ASP.

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“…The clinical impact of multiplex PCR panels in gram-positive BSI has also been examined in retrospective studies and quasiexperimental studies, as well as one randomized controlled trial. [35][36][37] Signifying the impact of AMS engagement via real-time pharmacist interpretation and intervention, even after mRDTs were in place, one quasi-experimental study, conducted in two community hospitals in Houston, TX, observed a significant decrease in mean time to optimal antimicrobial therapy (38.4 with AMS vs. 53.7 h preintervention, p < 0.001). 35 Optimization of antimicrobials for MSSA was likely the primary contributor to these overall findings, with mean time to optimal therapy decreasing from 57.4-37.3 h (p < 0.001).…”

Section: Ta B L E 2 (Continued)mentioning

confidence: 99%

From bottle to bedside: Implementation considerations and antimicrobial stewardship considerations for bloodstream infection rapid diagnostic testing

et al. 2023

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Antimicrobial stewardship (AMS) programs have been quick to adopt novel molecular rapid diagnostic technologies (mRDTs) for bloodstream infections (BSIs) to improve antimicrobial management. As such, most of the literature demonstrating the clinical and economic benefits of mRDTs for BSI is in the presence of active AMS intervention. Leveraging mRDTs to improve antimicrobial therapy for BSI is increasingly integral to AMS program activities. This narrative review discusses available and future mRDTs, the relationship between the clinical microbiology laboratory and AMS programs, and practical considerations for optimizing the use of these tools within a health system. Antimicrobial stewardship programs must work closely with their clinical microbiology laboratories to ensure that mRDTs are used to their fullest benefit while remaining cognizant of their limitations. As more mRDT instruments and panels become available and AMS programs continue to expand, future efforts must consider the expansion beyond traditional settings of large academic medical centers and how combinations of tools can further improve patient care.

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Evaluation of rapid polymerase chain reaction-based organism identification of gram-positive cocci for patients with a single positive blood culture

Cited by 8 publications

References 24 publications

Clinical outcomes associated with blood-culture contamination are not affected by utilization of a rapid blood-culture identification system

Clinical outcomes associated with blood-culture contamination are not affected by utilization of a rapid blood-culture identification system

Examining the clinical impact of rapid multiplex polymerase chain reaction‐based diagnostic testing for bloodstream infections in a national cohort of the Veterans Health Administration

From bottle to bedside: Implementation considerations and antimicrobial stewardship considerations for bloodstream infection rapid diagnostic testing

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