Sustained impact of a rapid microarray-based assay with antimicrobial stewardship interventions on optimizing therapy in patients with Gram-positive bacteraemia

Avdic, Edina; Wang, Ruibin; Li, David X.; Shulder, Stephanie; Carroll, Karen C.; Cosgrove, Sara E.

doi:10.1093/jac/dkx267

Cited by 32 publications

(23 citation statements)

References 14 publications

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“…Resistance gene detection and/or rapid phenotypic testing is important for early optimization of treatment. Several studies have demonstrated that when either of these is combined with stewardship interventions, the median time to optimal therapy, especially for methicillin-susceptible S. aureus (MSSA) and Enterococcus species, can be shortened by 14 h to more than 24 h (11,13,44,45). In this study, vanA prevalence was low (n ϭ 8 vanA enterococci) among the prospective samples, and no vanB-containing enterococci were detected.…”

Section: Discussionmentioning

confidence: 67%

“…Rapid detection of the causative organism in positive blood cultures, especially when combined with antimicrobial stewardship, reduces the interval between recognition of bacteremia and appropriate therapy by 18 to 24 h or longer (11)(12)(13)(14). In a systematic review by Timbrook et al, it was determined that when the use of rapid molecular diagnostic methods in the identification of the microorganism causing bloodstream infections was combined with antimicrobial stewardship interventions, mortality risk was significantly lower than with conventional microbiology methods (15), prompting the authors to recommend their use as standard of care.…”

mentioning

confidence: 99%

“…In a systematic review by Timbrook et al, it was determined that when the use of rapid molecular diagnostic methods in the identification of the microorganism causing bloodstream infections was combined with antimicrobial stewardship interventions, mortality risk was significantly lower than with conventional microbiology methods (15), prompting the authors to recommend their use as standard of care. Several pathogen-specific assays, broader multiplex panel tests applying nucleic acid amplification and nonamplified array technologies, and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) have been routinely incorporated into many laboratory workflows in the United States (11)(12)(13)(14)(15)(16). Many of these assays are limited by the number of pathogens they can detect, and almost all of them have difficulty with differentiation of species in polymicrobial bacteremia (17)(18)(19).…”

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confidence: 99%

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Clinical Performance of the Novel GenMark Dx ePlex Blood Culture ID Gram-Positive Panel

Carroll

Reid²,

Thornberg³

et al. 2020

J Clin Microbiol

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Rapid identification from positive blood cultures is standard of care (SOC) in many clinical microbiology laboratories. The GenMark Dx ePlex Blood Culture Identification Gram-Positive (BCID-GP) Panel is a multiplex nucleic acid amplification assay based on competitive DNA hybridization and electrochemical detection using eSensor technology. This multicenter study compared the investigational-use-only (IUO) BCID-GP Panel to other methods of identification of 20 Gram-positive bacteria, four antimicrobial resistance genes, and both Pan Candida and Pan Gram-Negative targets that are unique to the BCID-GP Panel. Ten microbiology laboratories throughout the United States collected residual, deidentified positive blood culture samples for analysis. Five laboratories tested both clinical and contrived samples with the BCID-GP Panel. Comparator identification methods included each laboratory’s SOC, which included matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) and automated identification systems as well as targeted PCR/analytically validated real-time PCR (qPCR) with bidirectional sequencing. A total of 2,342 evaluable samples (1,777 clinical and 565 contrived) were tested with the BCID-GP Panel. The overall sample accuracy for on-panel organisms was 89% before resolution of discordant results. For pathogenic Gram-positive targets (Bacillus cereus group, Enterococcus spp., Enterococcus faecalis, Enterococcus faecium, Staphylococcus spp., Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus lugdunensis, Listeria spp., Listeria monocytogenes, Streptococcus spp., Streptococcus agalactiae, Streptococcus anginosus group, Streptococcus pneumoniae, and Streptococcus pyogenes), positive percent agreement (PPA) and negative percent agreement (NPA) ranged from 93.1% to 100% and 98.8% to 100%, respectively. For contamination rule-out targets (Bacillus subtilis group, Corynebacterium, Cutibacterium acnes, Lactobacillus, and Micrococcus), PPA and NPA ranged from 84.5% to 100% and 99.9% to 100%, respectively. Positive percent agreement and NPA for the Pan Candida and Pan Gram-Negative targets were 92.4% and 95.7% for the former and 99.9% and 99.6% for the latter. The PPAs for resistance markers were as follows: mecA, 97.2%; mecC, 100%; vanA, 96.8%; and vanB, 100%. Negative percent agreement ranged from 96.6% to 100%. In conclusion, the ePlex BCID-GP Panel compares favorably to SOC and targeted molecular methods for the identification of 20 Gram-positive pathogens and four antimicrobial resistance genes in positive blood culture bottles. This panel detects a broad range of pathogens and mixed infections with yeast and Gram-negative organisms from the same positive blood culture bottle.

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Section: Discussionmentioning

confidence: 67%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical Performance of the Novel GenMark Dx ePlex Blood Culture ID Gram-Positive Panel

Carroll

Reid²,

Thornberg³

et al. 2020

J Clin Microbiol

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“…In comparison to conventional culture methods, these technological advances can optimize microbiology workflows, decrease time to result, and offer clinicians the potential to improve time to antibiotic tailoring ( 6 ). Studies of rapid PCR-based organism identification and antimicrobial resistance markers have shown improved outcomes such as shortened time to targeted therapy, reduced time to antimicrobial de-escalation, decreased costs, and reduced patient hospital length of stay (LOS) ( 7 – 12 ). However, these evaluations have been limited to mostly Gram-positive (GP) BSI, and two rapid blood culture diagnostic methodologies have not been compared.…”

Section: Introductionmentioning

confidence: 99%

“…However, these evaluations have been limited to mostly Gram-positive (GP) BSI, and two rapid blood culture diagnostic methodologies have not been compared. Moreover, a comparison of patient outcomes between rapid molecular ID and fast ID and phenotypic AST has yet to be published ( 7 – 9 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

Pharmacist-Driven Implementation of Fast Identification and Antimicrobial Susceptibility Testing Improves Outcomes for Patients with Gram-Negative Bacteremia and Candidemia

Sheth

Miller

Prouse

et al. 2020

Antimicrob Agents Chemother

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Background: Bloodstream infections (BSI) are associated with increased morbidity and mortality, especially when caused by gram-negative or fungal pathogens. The objective of this study was to assess the impact of fast ID/AST with the Accelerate Pheno ™ system (AXDX) from May 2018 to December 2018 on antibiotic therapy and patient outcomes. Methods: A pre-post quasi-experimental study of 200 patients (100 pre-AXDX implementation and 100 post-AXDX implementation) was conducted. The primary endpoints measured were time to first antibiotic intervention, time to most targeted antibiotic therapy, and 14-day hospital mortality. Secondary endpoints included hospital and intensive care unit (ICU) length of stay (LOS), antibiotic intensity score at 96 hours, and 30-day readmission rates. Results: Of 100 patients with gram-negative bacteremia or candidemia in each cohort, 84 in the pre-implementation group and 89 in the AXDX group met all inclusion criteria. The AXDX group had a decreased time to first antibiotic intervention (26.3 vs 8.0 p=0.003), hours to most targeted therapy (14.4 vs 9, p=0.03), hospital LOS (6 vs 8, p=0.002), and average antibiotic intensity score at 96 hours (16 vs 12, p=0.002). Both groups had a comparable 14-day mortality (0% vs 3.6%, p = 0.11). Conclusion: In this analysis of patients with gram-negative bacteremia or candidemia, fast ID/AST implementation was associated with decreased hospital LOS, decreased use of broad-spectrum antibiotics, shortened time to targeted therapy, and an improved utilization of antibiotics within the first 96 hours of therapy.

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From bottle to bedside: Implementation considerations and antimicrobial stewardship considerations for bloodstream infection rapid diagnostic testing

et al. 2023

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Antimicrobial stewardship (AMS) programs have been quick to adopt novel molecular rapid diagnostic technologies (mRDTs) for bloodstream infections (BSIs) to improve antimicrobial management. As such, most of the literature demonstrating the clinical and economic benefits of mRDTs for BSI is in the presence of active AMS intervention. Leveraging mRDTs to improve antimicrobial therapy for BSI is increasingly integral to AMS program activities. This narrative review discusses available and future mRDTs, the relationship between the clinical microbiology laboratory and AMS programs, and practical considerations for optimizing the use of these tools within a health system. Antimicrobial stewardship programs must work closely with their clinical microbiology laboratories to ensure that mRDTs are used to their fullest benefit while remaining cognizant of their limitations. As more mRDT instruments and panels become available and AMS programs continue to expand, future efforts must consider the expansion beyond traditional settings of large academic medical centers and how combinations of tools can further improve patient care.

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Sustained impact of a rapid microarray-based assay with antimicrobial stewardship interventions on optimizing therapy in patients with Gram-positive bacteraemia

Abstract: A real-time AS intervention implemented alongside introduction of the Verigene BC-GP assay led to improvements in antibiotic therapy for patients with bacteraemia due to Gram-positive cocci, even after the AS intervention was discontinued.

Cited by 32 publications

References 14 publications

Clinical Performance of the Novel GenMark Dx ePlex Blood Culture ID Gram-Positive Panel

Clinical Performance of the Novel GenMark Dx ePlex Blood Culture ID Gram-Positive Panel

Pharmacist-Driven Implementation of Fast Identification and Antimicrobial Susceptibility Testing Improves Outcomes for Patients with Gram-Negative Bacteremia and Candidemia

From bottle to bedside: Implementation considerations and antimicrobial stewardship considerations for bloodstream infection rapid diagnostic testing

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