Rapid Molecular Panels: What Is in the Best Interest of the Patient? A Review of Patient Outcome Studies for Multiplex Panels Used in Bloodstream, Respiratory, and Neurological Infections

Sullivan, Kaede V.

doi:10.1016/j.clinmicnews.2017.08.001

Cited by 6 publications

(4 citation statements)

References 32 publications

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“…Tras la intervención, se reportan terapias dirigidas rápidas, sin esperar el resultado del antibiograma, por lo que las pruebas rápidas de diagnóstico, ayudaron a tomar las decisiones basada en la bacteria identificada 8,10,11 . Además se reporta una menor utilización de antibióticos empíricos inapropiados 3,[12][13][14] , especialmente en el grupo de bacterias Gram positivas 15 , consideramos que lo anterior puede corresponder a que los genes de resistencia para bacterias gram positivas testeados por la prueba, como el mecA y van A/B, ayudan al médico a la toma de decisiones para desescalar o suspender antibióticos, lo que no sucede con bacterias gram negativas, puesto que en hospitales con índices de resistencia bajos para blaKPC, la información suministrada sobre la resistencia de carbapenemasas es de menor utilidad que la tipificación de beta lactamasas de espectro extendido (ESBLs/BLEEs). Por lo tanto, la decisión de desescalar carbapenémicos queda sometida al análisis de factores de riesgo de pacientes que puedan tener este tipo de resistencia 16 , especialmente para bacterias como Klebsiella spp., Pseudomonas spp.…”

Section: Discussionunclassified

Uso racional de antibióticos y tecnología FilmArray para identificación rápida de bacteriemias en unidad de cuidados intensivos pediátrica

Mazzillo-Vega

Bravo

2020

Rev Chil Pediatr

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Las infecciones graves son la principal causa de ingreso a cuidados intensivos pediátricos. El panel FilmArray BCID permite identificar rápidamente a microorganismos causantes de bacteriemias.Objetivo: evaluar la eficacia de la identificación rápida de microorganismos asociado a un Programa de Uso Racional de Antibióticos (URA) en reducir los tiempos de terapias antibióticas, en un hospital pediátrico.Pacientes y Método: Estudio retrospectivo, que incluyó 100 pacientes, en su primer episodio de bacteriemia, divididos en 2 grupos de 50 cada uno: Intervención (FilmArray BCID y programa URA) y Controles históricos pareados para la misma especie del microrganismo identificado (microbiología convencional). Las variables evaluadas fueron los tiempos de identificación microbiana, latencia de la terapia dirigida y de desescalar antibióticos.Resultados: Los grupos fueron comparables en características demográficas, foco de infección y etiología de bacteriemia. El tiempo promedio de identificación de microorganismos fue de 23 h (IC 95% 12,4-26,7) en el grupo intervención, y 70,5 h (IC 95% 65,2-78,6) en el control (p < 0,05), mientras que la latencia de inicio de terapia dirigida fue de 27,9 h (IC 95% 22,3-32,8) y 71,9 h (IC 95% 63,2-77,8) respectivamente (p < 0,05). El tiempo de desescalar o suspender antibióticos fue de 6,4 h (IC 95% 2,76-9,49) y 22 h (IC 95% 6,74-35,6) en los grupos mencionados (p > 0,05).Conclusión: El panel FilmArray BCID articulado a un programa URA, contribuye a la identificación de los microorganismos causantes de bacteriemias en menor tiempo que los métodos convencionales, siendo una herramienta que optimiza las terapias antibióticas en niños críticamente enfermos.

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Section: Discussionunclassified

Uso racional de antibióticos y tecnología FilmArray para identificación rápida de bacteriemias en unidad de cuidados intensivos pediátrica

Mazzillo-Vega

Bravo

2020

Rev Chil Pediatr

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“…They indicated that this assay had a sensitivity of 98.9-100% and specificity of 80% (Altun et al, 2013). The recent FDA-approved Accelerate Pheno assay (Accelerate Diagnostics, Tucson, AZ) employs time-lapse microscopy coupled with image analysis for susceptibility assays to pre-define panels of drugs on blood cultures of several Gram-negative (E. coli, Klebsiella species, Enterobacter species, Proteus species, Citrobacter species, S. marcescens, Pseudomonas aeruginosa, A. baumannii), Gram-positive (S. aureus, Staphylococcus lugdunensis, CoNS species, E. faecalis, E. faecium, Streptococcus species), and yeast (Candida albicans, Candida glabrata) isolates in 6 hours (Sullivan, 2017).…”

Section: Molecular Methods For Pathogen Identification In Positive Blmentioning

confidence: 99%

Epidemiology of bloodstream infection in Saudi Arabia

Ozbak¹

2018

Afr. J. Microbiol. Res.

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Bloodstream infections are a challenge to clinicians due to high rates of morbidity and mortality. Moreover, rational antimicrobial therapy, if promptly started, can improve the prognosis of sepsis. The gold-standard blood culture has some limitations and it takes time to complete (about 2-5 days). This leaves the clinicians to start immediately broad-range antimicrobial therapy until microbiology culture's results available that may lead to complicate situation of patient further. Therefore, there is an urgent need for the development of more advanced diagnostic approaches that can overcome limitations of culture-based methods. This review gives an overview of the BSIs and its epidemiology over several cities and hospitals in Saudi Arabia. It also encompasses the diverse molecular diagnostic modalities developed for the rapid detection and identification of BSIs. Furthermore, the growing understanding of the host's inflammatory responses to infections has led to the discovery of immunological biomarkers as diagnostic tools for sepsis-related BSI. The rational use of immunological and molecular diagnostic markers in clinical settings may speed up diagnosis and prognosis of septic patients. This review shows that the percentage of BSIs in Saudi Arabia, from 1983 to 2015, ranges from 1% to 11% among patients with confirmed infection. It also indicated that Staphylococcus aureus and coagulase negative staphylococci (CoNS) were the most common Gram-positive pathogens; while Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were the most Gram-negative ones from patients with BSI. The recommendation of this review is to initiate new surveillance systems of BSI in different regions and hospitals in Saudi Arabia and determining the antibiotic susceptibility profile to design antibiograms that may improve the antibiotic stewardship program for treating BSIs. A comparative study should be conducted for patients suspected to have sepsis, using the standard blood cultures, immunological markers and rapid molecular assays to set up a panel to help diagnose BSIs rapidly. This will allow early and optimal patient management and treatment in Saudi Arabia and therefore decrease overall healthcare costs.

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“…Since its appearance on the market, scientific evidence has been generated about its impact on the different process and outcome indicators [17,18]. The former include time to optimisation of antibiotic treatment and duration of antibiotic therapy.…”

Section: What Is the Available Evidence On The Impact Of Using These ...mentioning

confidence: 99%

Value of syndromic panels in the management of severe community-acquired pneumonia

Burillo¹,

Candel²,

Canut³

2022

Rev Esp Quimioter

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Community-acquired pneumonia requiring hospital admission is a prevalent and potentially serious infection, especially in high-risk patients (e.g., those requiring ICU admission or immunocompromised). International guidelines recommend early aetiological diagnosis to improve prognosis and reduce mortality. Syndromic panels that detect causative pathogens by molecular methods are here to stay. They are highly sensitive and specific for detecting the targets included in the test. A growing number of studies measuring their clinical impact have observed increased treatment appropriateness and decreased turnaround time to aetiological diagnosis, need for admission, length of hospital stay, days of isolation, adverse effects of medication and hospital costs. Its use is recommended a) per a pre-established protocol on making the diagnosis and managing the patient, b) together with an antimicrobial stewardship programme involving both the Microbiology Service and the clinicians responsible for the patient, and c) the final evaluation of the whole process. However, we recall that microbiological diagnosis with traditional methods remains mandatory due to the possibility that the aetiological agent is not included among the molecular targets and to determine the antimicrobial susceptibility of the pathogens detected.

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Rapid Molecular Panels: What Is in the Best Interest of the Patient? A Review of Patient Outcome Studies for Multiplex Panels Used in Bloodstream, Respiratory, and Neurological Infections

Cited by 6 publications

References 32 publications

Uso racional de antibióticos y tecnología FilmArray para identificación rápida de bacteriemias en unidad de cuidados intensivos pediátrica

Uso racional de antibióticos y tecnología FilmArray para identificación rápida de bacteriemias en unidad de cuidados intensivos pediátrica

Epidemiology of bloodstream infection in Saudi Arabia

Value of syndromic panels in the management of severe community-acquired pneumonia

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