Impact of a rapid peptide nucleic acid fluorescence in situ hybridization assay on treatment of Candida infections

Heil, Emily L.; Daniels, Lindsay M.; Long, Dustin; Rodino, Kyle G.; Weber, David J.; Miller, Melissa B.

doi:10.2146/ajhp110604

Cited by 62 publications

(98 citation statements)

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“…To try to further improve the time to targeted therapy, we will implement an antimicrobial stewardship intervention in which CHROMagar results will be paged to an on-call pharmacist who will then collaborate with the medical team to switch to targeted therapy. This approach has previously been successful at our institution (9). Regardless of our future endeavors, this study supports the idea that rapid culture-based detection of MRSA and MSSA plays a role in antimicrobial stewardship by decreasing the time that it takes to place patients on targeted antimicrobial therapy.…”

Section: Discussionsupporting

confidence: 72%

Clinical Outcomes with Rapid Detection of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Routine Blood Cultures

et al. 2013

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e Staphylococcus aureus is a common cause of bacteremia, with a substantial impact on morbidity and mortality. Because of increasing rates of methicillin-resistant Staphylococcus aureus, vancomycin has become the standard empirical therapy. However, beta-lactam antibiotics remain the best treatment choice for methicillin-susceptible strains. Placing patients quickly on the optimal therapy is one goal of antimicrobial stewardship. This retrospective, observational, single-center study compared 33 control patients utilizing only traditional full-susceptibility methodology to 22 case patients utilizing rapid methodology with CHROMagar medium to detect and differentiate methicillin-resistant and methicillin-susceptible Staphylococcus aureus strains hours before full susceptibilities were reported. The time to targeted therapy was statistically significantly different between control patients (mean, 56.5 ؎ 13.6 h) and case patients (44.3 ؎ 17.9 h) (P ‫؍‬ 0.006). Intensive care unit status, time of day results emerged, and patient age did not make a difference in time to targeted therapy, either singly or in combination. Neither length of stay (P ‫؍‬ 0.61) nor survival (P ‫؍‬ 1.0) was statistically significantly different. Rapid testing yielded a significant result, with a difference of 12.2 h to targeted therapy. However, there is still room for improvement, as the difference in time to susceptibility test result between the full traditional methodology and CHROMagar was even larger (26.5 h). This study supports the hypothesis that rapid testing plays a role in antimicrobial stewardship by getting patients on targeted therapy faster.

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Section: Discussionsupporting

confidence: 72%

Clinical Outcomes with Rapid Detection of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Routine Blood Cultures

et al. 2013

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“…These effects are more pronounced in patients with BSI where use of rapid diagnostics coupled with pharmacy intervention to improve antibiotic optimization resulted in significant reductions in hospital length of stay (LOS), healthcare costs, and mortality. [8][9][10][11][12][13] To date, the role of rapid diagnostics in ASPs has largely been studied in tertiary or quaternary care medical centers with dedicated infectious diseases pharmacists, complex patient populations, and robust clinical laboratory services. Thus, limited data are available in lower acuity community hospital settings.…”

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confidence: 99%

Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time

Lockwood

Perez

Musick

et al. 2016

Infect. Control Hosp. Epidemiol.

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objective. To assess the impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) mass spectrometry for rapid pathogen identification directly from early-positive blood cultures coupled with an antimicrobial stewardship program (ASP) in two community hospitals. Process measures and outcomes prior and after implementation of MALDI-TOF/ASP were evaluated.design. Multicenter retrospective study.setting. Two community hospitals in a system setting, Houston Methodist (HM) Sugar Land Hospital (235 beds) or HM Willowbrook Hospital (241 beds).patients. Patients ≥18 years of age with culture-proven Gram-negative bacteremia.intervention. Blood cultures from both hospitals were sent to and processed at our central microbiology laboratory. Clinical pharmacists at respective hospitals were notified of pathogen ID and susceptibility results.results. We evaluated 572 patients for possible inclusion. After pre-defined exclusion criteria, 151 patients were included in the pre-intervention group and 242 were included in the intervention group. After MALDI-TOF/ASP implementation, the mean identification time after culture positivity was significantly reduced from 32 hours (±16 hours) to 6.5 hours (±5.4 hours) (P < .001); mean time to susceptibility results was significantly reduced from 48 (±22) hours to 23 (±14) hours (P < .001); and time to therapy adjustment was significantly reduced from 75 (±59) hours to 30 (±30) hours (P < .001). Mean hospital costs per patient were $3,411 less in the intervention group compared with the pre-intervention group ($18,645 vs $15,234; P = .04).conclusion. This study is the first to analyze the impact of MALDI-TOF coupled with an ASP in a community hospital setting. Time to results significantly differed with the use of MALDI-TOF, and time to appropriate therapy was significantly improved with the addition of ASP.

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“…False-positive S. pneumoniae results do not limit the utility of the assay, as we were still able to develop a treatment algorithm to promote the use of targeted regimens based on the results generated by the BC-GP assay. Although we have previously shown that a pharmacy-based intervention strategy is effective at our institution (8), the effectiveness of our BC-GP algorithm for streptococci and enterococci will need to be measured.…”

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confidence: 99%

Development of a Treatment Algorithm for Streptococci and Enterococci from Positive Blood Cultures Identified with the Verigene Gram-Positive Blood Culture Assay

et al. 2013

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Bloodstream infections (BSI) are a leading cause of morbidity and mortality. In 2009, BSI were the cause of nearly 36,000 deaths in the United States (1). Health care-associated BSI are a major contributor to these statistics, being associated with nearly 75,000 infections a year with a mortality rate of approximately 25% (2). Enterococci are the third leading cause of health careassociated BSI (3), and inappropriate antimicrobial therapy has been shown to be an independent risk factor for the increased mortality of BSI (4). The Nanosphere Verigene Gram-positive blood culture (BC-GP) assay (Nanosphere, Northbrook, IL) is an on-demand FDA-cleared test for the identification of 15 targets from positive blood culture bottles. Previous studies have shown this assay to be an effective method for determining the identity of Gram-positive organisms, showing 92 to 95% overall concordance for organism identification (5, 6); however, the implementation of an algorithm for treatment based on BC-GP test results has not been proposed. The current work focuses on the performance of the assay specifically in cultures where streptococci and enterococci are suspected based on the primary Gram stain and on the algorithm we have developed for treatment based on the BC-GP results.We first performed an evaluation of the BC-GP assay on the Nanosphere Verigene system. Routine blood cultures were collected using FAN aerobic (FA), pediatric FAN (PF), and standard anaerobic (SA) bottles and subsequently incubated on the BacT/ Alert (bioMérieux, Durham, NC) system. Positive blood cultures were Gram stained, plated onto solid medium, and stored upright at 35°C for up to 5 days. Subcultures were evaluated according to standard laboratory protocols, and organisms were identified using a combination of morphological and phenotypic methods as well as matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (Vitek MS; bioMérieux). Notably, the Vitek MS accurately distinguishes between Streptococcus pneumoniae and Streptococcus mitis/Streptococcus oralis (7). Positive blood cultures with a Gram stain of Gram-positive cocci in pairs and/or chains were further evaluated with the BC-GP assay according to the manufacturer's recommendations. The BC-GP targets analyzed include Enterococcus faecalis, Enterococcus faecium, Streptococcus spp., Streptococcus agalactiae, Streptococcus anginosus group, S. pneumoniae, Streptococcus pyogenes, and the resistance determinants vanA and vanB.Seventy-eight consecutive positive blood cultures from 74 patients with an initial Gram stain result containing Gram-positive cocci in pairs and/or chains were evaluated with the BC-GP assay, of which 72 had at least one target detected. Of the six cultures for which no target was detected, three grew organisms (Acinetobacter sp., Atopobium sp., B. cereus group) for which the assay does not target, and two grew Streptococcus vestibularis, which has not been evaluated by the manufacturer according to the package insert. The remaining negative BC...

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Impact of a rapid peptide nucleic acid fluorescence in situ hybridization assay on treatment of Candida infections

Abstract: Implementing a PNA FISH test to identify Candida species from yeast-positive blood cultures in conjunction with a pharmacy-driven antimicrobial stewardship protocol decreased the time to targeted antifungal therapy and the time to culture clearance.

Cited by 62 publications

References 9 publications

Clinical Outcomes with Rapid Detection of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Routine Blood Cultures

Clinical Outcomes with Rapid Detection of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Routine Blood Cultures

Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time

Development of a Treatment Algorithm for Streptococci and Enterococci from Positive Blood Cultures Identified with the Verigene Gram-Positive Blood Culture Assay

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