The Impact of Integrating Rapid PCR-Based Blood Culture Identification Panel to an Established Antimicrobial Stewardship Program in the United Arab of Emirates

Abstract

Background: Studies have shown improvement in the outcome of blood stream infections (BSI) due to the use of Rapid PCR-Based Blood Culture Identification Panel (BCID) in Antimicrobial stewardship programs (ASP). There is currently no data on the use of BCID with ASP in the United Arab Emirates (UAE). Method: Pre-post quasiexperimental study included hospitalized patients with BSI, their positive blood cultures on BCID were studied in 2 groups: conventional culture with ASP (AS), and BCID with ASP (BCID). The primary outcomes were time to first appropriate antimicrobial therapy, infection related length of stay (LOS), ICU admission, 14 days bacteremia recurrence and in-hospital mortality. Secondary outcomes were 30 days reinfection rate, hospital cost and ASP interventions. Results: Out of total 477 positive blood cultures, 206 (AS and BCID) with real BSI were included. The time needed for organism identification was shorter in the BCID group than in the AS group (1.3 h vs. 51 h; P = 0.0002). BCID had a shorter time to appropriate antimicrobial therapy than AS (17.8 h vs.45 h; P = 0.0004). No statistical difference was observed in mortality rate, 14 days bacteremia recurrence, ICU admission, hospital cost, LOS or ASP interventions. Conclusion: Implementing BCID to ASP significantly decreased the time needed to identify the organism and time to appropriate antimicrobial therapy. Similarly, LOS and hospital cost were reduced, however, the reduction was not statistically significant.

Evaluation of Microbiological Performance and the Potential Clinical Impact of the ePlex® Blood Culture Identification Panels for the Rapid Diagnosis of Bacteremia and Fungemia

“…Nevertheless, our data are in accordance with other clinical studies that have already proved rapid molecular panels help to decrease time to identification, time to effective therapy and time to escalation or de-escalation by 5 to 40 h (Banerjee et al, 2015;MacVane and Nolte, 2016;Timbrook et al, 2017). Panel-based rapid molecular testing is also important for good clinical practice as they allow a reduction in the use of broadspectrum antibiotics and the treatment of contaminants, while showing variable impact among studies with regard to mortality, length of stay or costs (Banerjee et al, 2015;MacVane and Nolte, 2016;Pardo et al, 2016;Nasef et al, 2020). These panels with enlarged numbers of species and antimicrobial resistance genes detected should further increase the impact of rapid molecular diagnosis for patients with BSI.…”

Assessment of antibiotic appropriateness at discharge: experience from a quaternary care hospital setting

“…There are several intermediate to advanced-level initiatives implemented through the programme, including prospective audit with intervention and feedback, prior authorization of broad-spectrum antimicrobials, facility-specific antimicrobial guidelines, real-time rapid diagnostics, real-time computerized surveillance system, and real-time dashboard for ASP metrics. 14 , 15 In addition, members of the ASP are currently represented on the National Antimicrobial Resistance (AMR) taskforce. However, our programme has not yet focused on transitions of care and this is our first assessment of this under-recognized area within ASPs that is recently coming into the spotlight as a result of new research findings.…”

Design and Implementation of an Antimicrobial Stewardship Certificate Program in the United Arab Emirates

“…The program is co-directed by a PGY2-trained Infectious Diseases (ID) pharmacist who oversees both the day-to-day clinical activities and the ASP Subcommittee, which addresses antimicrobial formulary changes as well as updates to antimicrobial policies, protocols, and guidelines. The program follows the Centers for Disease Control and Prevention (CDC) elements for antimicrobial stewardship, including a prospective audit with intervention and feedback, prior-authorization of broadspectrum antimicrobials, facility-specific antimicrobial guidelines, rapid diagnostics, a realtime computerized surveillance system, and a real-time dashboard for ASP metrics [25,26]. In addition, members of the ASP are currently represented on the National Antimicrobial Resistance (AMR) taskforce.…”