Rapid Diagnostics for Blood Cultures: Supporting Decisions for Antimicrobial Therapy and Value-Based Care

Abstract

Bacteremia and sepsis are critically important syndromes with high mortality, morbidity, and associated costs. Bloodstream infections and sepsis are among the top causes of mortality in the US, with >600 deaths each day. Most septic patients can be found in emergency medicine departments or critical care units, settings in which rapid administration of targeted antibiotic therapy can reduce mortality. Unfortunately, routine blood cultures are not rapid enough to aid in the decision of therapeutic intervention at the onset of bacteremia. As a result, empiric, broad-spectrum treatment is common-a costly approach that may fail to target the correct microbe effectively, may inadvertently harm patients via antimicrobial toxicity, and may contribute to the evolution of drug-resistant microbes. To overcome these challenges, laboratorians must understand the complexity of diagnosing and treating septic patients, focus on creating algorithms that rapidly support decisions for targeted antibiotic therapy, and synergize with existing emergency department and critical care clinical practices put forth in the Surviving Sepsis Guidelines. IMPACT STATEMENTPatients infected with bacteria in their bloodstream can benefit from deployment of laboratory technology that is more rapid and more accurate than historical methods. This review will characterize the current and novel laboratory technology and the potential effect of technology to improve care for patients with blood stream infections. The review provides a snapshot of emerging technologies for laboratorians to consider as they strategize about how best to support quality initiatives focusing on sepsis in their organizations.

Comparison of Accelerate PhenoTest™ BC Kit vs. MALDI-TOF MS/VITEK®2 System for the Rapid Identification and Antimicrobial Susceptibility Testing of Gram-negative Bacilli Causing Bloodstream Infections

“…Short incubation MALDI and AST (using an automated AST platform such as VITEK ® 2), direct MALDI and AST, AXDX, peptide nucleic acid fluorescence in situ hybridization (PNA FISH), polymerase chain reaction (PCR)-based assays, and the T2Bacteria ® panel (T2 Biosystems) are the most notable. 22,23 The T2Bacteria ® panel has the advantage of not requiring blood culture incubation prior to identification, but does not provide susceptibility information. The main limitation with most of these panels is their high cost.…”

Comparison of Accelerate PhenoTest BC Kit and MALDI-TOF MS/VITEK 2 System for the rapid identification and antimicrobial susceptibility testing of gram-negative bacilli causing bloodstream infections

“…Because of these limitations, AXDX is difficult to consider implementing in our high-volume laboratory. It may have a niche in other situ hybridization, polymerase chain reaction-based assays, and the T2Bacteria panel (T2 Biosystems, Lexington, MA) are the most notable (24,25). The T2Bacteria panel has the advantage of not requiring blood culture incubation before ID, but it does not provide susceptibility information.…”

Antimicrobial susceptibility testing for Gram positive cocci towards vancomycin using scanning electron microscopy

“…The early detection of bacterial pathogens and their antimicrobial susceptibility is urgently needed to treat infections with appropriate and faster targeted therapy ( Khatib et al., 2006 ; Lodise et al., 2003 ; Wolk and Johnson, 2019 ). One of the major worldwide causes of nosocomial and community-acquired bacteriemia is Gram-positive bacteria, particularly Gram-positive cocci.…”