Impact of Accelerate Pheno and BacT/Alert Virtuo on Clinical Processes and Outcomes in Patients with Sepsis and Concurrent Gram-Negative Bacteremia

Abstract

Background: Accelerate Pheno system and BacT/ALERT VIRTUO may improve bacteremia management. This study evaluated the impact of both devices on outcomes in patients with sepsis and concurrent gram-negative bacteremia. Methods: This quasi-experimental study included a retrospective pre-implementation and a prospective post-implementation group. Patients ≥18 years old with gram-negative bacteremia were included. Patients with neutropenia, pregnancy, were transferred from an outside hospital with active bloodstream infection, or polymicrobial bacteremia were excluded. Blood culture incubation in the BacT/ALERT 3D and microdilution antimicrobial susceptibility testing from culture plate growth was used prior to implementation of BacT/ALERT VIRTUO and Accelerate Pheno. MALDI-TOF identification directly from blood culture was used pre- and post-implementation. Time to gram-stain, identification, susceptibility reporting, initiation of narrow spectrum gram-negative therapy at 72 hours, 30-day inpatient mortality, sepsis resolution, and hospital length of stay were evaluated. Results: 116 patients were included (63 pre-implementation, 53 post-implementation). Median time to gram-stain and susceptibility results were significantly shorter post-implementation (P < 0.001). The post-implementation group had an improved hazard for narrow spectrum gram-negative therapy at 72 hours (HR [95% CI] = 2.685 [1.348 – 5.349]), reduced hazard for 30-day inpatient mortality (aHR: 0.150 [0.026 – 0.846]) and improved sepsis resolution (77.8% vs. 92.5%, P = 0.030). Hospital length of stay was unchanged between groups. Conclusion: The implementation of BacT/Alert VIRTUO and the Accelerate Pheno system improved microbiology laboratory processes, antibiotic utilization processes and clinical outcomes. These data support the use of rapid diagnostics in sepsis with concurrent gram-negative bacteremia.

Using Targeted Liquid Chromatography-Tandem Mass Spectrometry to Rapidly Detect β-Lactam, Aminoglycoside, and Fluoroquinolone Resistance Mechanisms in Blood Cultures Growing E. coli or K. pneumoniae

“…Currently used growth inhibition techniques delay the time to final AST results of positive blood cultures ( Florio et al, 2018 ; Lamy et al, 2020 ). In turn, this can delay the time to optimal therapy in septic patients ( Timbrook et al, 2017 ; Babowicz et al, 2021 ). The use of rapid diagnostic tests has been associated with a reduction in mortality ( Timbrook et al, 2017 ; Guillamet et al, 2019 ).…”

Molecular Analysis With 16S rRNA PCR/Sanger Sequencing and Molecular Antibiogram Performed on DNA Extracted From Valve Improve Diagnosis and Targeted Therapy of Infective Endocarditis: A Prospective Study

“…Blood and valve cultures: standard of care as elsewhere described [ 27 ]. Briefly, BC were incubated for 5 days in bioMerieux Bact/Alert 3D platform, VC were homogenized by a rotor-stator unit (IKA Ultra-Turrax) and incubated for 72 hours.…”

Empirical antibiotic therapy for difficult-to-treat Gram-negative infections: when, how, and how long?

“…No differences were observed between groups with respect to the length of hospital stay and 28-day mortality [12]. In a quasi-experimental study (with a retrospective preimplementation phase and a prospective postimplementation phase) conducted among 116 patients with GNB bloodstream infection, the implementation of the BacT/Alert Virtuo system (aimed at reducing the time to automated blood culture positivity detection) and the Accelerate Pheno system (which combines rapid identification by means of fluorescent in situ hybridization with rapid phenotypic AST by means of time-lapse automated microscopy [75]) led to improved rates of narrow-spectrum anti-GNB therapy at 72 h (hazard ratio 2.7, with 95% CI from 1.3 to 5.3), reduced 30-day in-hospital mortality (hazard ratio 0.2, with 95% CI from 0.0 to 0.8), whereas no differences were observed between the two periods with respect to the length of hospital stay [13]. Another recent quasi-experimental study evaluated the impact of the Accelerate Pheno system on relevant clinical outcomes among 854 patients with bloodstream infections [15].…”

“…Furthermore, the increased availability of either phenotypical or molecular rapid diagnostic tests in real-life scenarios is an additional, potential game changer. Indeed, if properly used, rapid tests could considerably reduce the duration of inappropriate empirical therapy [12–17,18 ▪ ,19–23].…”