Impact of phenotypic rapid diagnostic assay on duration of empiric antibiotics for gram-negative bacteremia

Abstract

Objective: Rapid diagnostic tests (RDTs) are increasingly being implemented as antimicrobial stewardship tools to facilitate antibiotic modification and reduce complications related to their overutilization. We measured the clinical impact of a phenotypic RDT with antimicrobial stewardship (AMS) in the setting of gram-negative bacteremia. Setting and participants: In this single-center retrospective cohort study, we evaluated adult patients with gram-negative bacteremia who received at least 72 hours of an antibiotic. Methods: The primary outcome was the duration of empiric antibiotic therapy for gram-negative bacteremia. Secondary outcomes included time-to-directed therapy, proportion of modifications, hospital length of stay (LOS), and subsequent infection with a multidrug-resistant organism (MDRO) or C. difficile infection (CDI). Results: The duration of empiric antibiotics decreased in the RDT+AMS group (4 days vs 2 days; P < .01). Time to directed therapy decreased from 75.0 to 27.9 hours (P < .01). Conclusions: The clinical outcomes of LOS, MDRO, and CDI were reduced. The phenotypic RDT demonstrated an improvement in stewardship measures and clinical outcomes.

Mortality Due to Multidrug-Resistant Gram-Negative Bacteremia in an Endemic Region: No Better Than a Toss of a Coin

“…In this study, we also evaluated the possible effect of using RDT on mortality in patients with MDR GNB bacteremia. Mohayya et al recently showed that reduction in the duration of inadequate empirical treatment was associated with better outcomes and although not statistically significant, the finding was notable and may favor the use of RDT as a useful tool for adequate targeted treatment in the context of antimicrobial resistance strategies [ 55 ]. Although the implementation of antibiotic stewardship protocols and the progress and handy release of diagnostic tools might optimize appropriate empirical therapy, selecting appropriate empirical therapy remains a challenge, particularly for resistant pathogens.…”

Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement

“…A recent consensus document produced by several scientific societies, brings together several recommendations, including the concept of the importance of rapid diagnostics in the identification and determination of antibiotic susceptibility [46]. These methods also reduce the duration of empirical antimicrobial therapy [46,47]. The integration of a molecular and a phenotypic approach is relevant, considering that there has been a change in the Cortegiani et al J Anesth Analg Crit Care (2023) 3:11 current epidemiology regarding carbapenemase-resistant Enterobacterales.…”