Kathrin Ehren1, Arne Meißner1,2, Nathalie Jazmati1, Julia Wille1,3, Norma Jung4, Jörg Janne Vehreschild3,4, Martin Hellmich5, Harald Seifert1,3. 1. Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Germany. 2. Department of Hospital Hygiene and Infection Control, University Hospital of Cologne, Germany. 3. German Center for Infection Research, Partner Site Bonn-Cologne, University Hospital of Cologne, Germany. 4. Department I for Internal Medicine, University Hospital of Cologne, Germany. 5. Institute of Medical Statistics and Computational Biology, University Hospital of Cologne, Germany.
Abstract
BACKGROUND: Timely availability of microbiological results from positive blood cultures is essential to enable early pathogen-directed therapy. The Accelerate Pheno system (ADX) is a novel technology using fluorescence in situ hybridization for rapid species identification (ID) and morphokinetic bacterial analysis for phenotypic antimicrobial susceptibility testing (AST), with promising results. Yet the impact of this technology on clinical management and patient outcome remains unclear. METHODS: We conducted a quasiexperimental before-and-after observational study and analyzed 3 groups with different diagnostic and therapeutic pathways following recent integration of ADX: conventional microbiological diagnostics with and without antimicrobial stewardship program (ASP) intervention, and rapid diagnostics (ADX in addition to conventional standard) with ASP intervention. Primary endpoints were time to adequate, to optimal and to step-down antimicrobial therapy. Secondary endpoints were antimicrobial consumption, in-hospital mortality, length of stay (LOS), and the incidence of Clostridioidesdifficile infection (CDI). RESULTS: Two hundred four patients (conventional diagnostics, n = 64; conventional diagnostics + ASP, n = 68; rapid diagnostics + ASP; n = 72) were evaluated. The use of ADX significantly decreased time from Gram stain to ID (median, 23 vs 2.2 hours, P < .001) and AST (median, 23 vs 7.4 hours, P < .001), from Gram stain to optimal therapy (median, 11 vs 7 hours, P = .024) and to step-down antimicrobial therapy (median, 27.8 vs 12 hours, P = .019). However, groups did not differ in antimicrobial consumption, duration of antimicrobial therapy, mortality, LOS, or incidence of CDI. CONCLUSIONS: Use of ADX significantly reduced time to ID and AST as well as time to optimal antimicrobial therapy but did not affect antimicrobial consumption and clinical outcome.
BACKGROUND: Timely availability of microbiological results from positive blood cultures is essential to enable early pathogen-directed therapy. The Accelerate Pheno system (ADX) is a novel technology using fluorescence in situ hybridization for rapid species identification (ID) and morphokinetic bacterial analysis for phenotypic antimicrobial susceptibility testing (AST), with promising results. Yet the impact of this technology on clinical management and patient outcome remains unclear. METHODS: We conducted a quasiexperimental before-and-after observational study and analyzed 3 groups with different diagnostic and therapeutic pathways following recent integration of ADX: conventional microbiological diagnostics with and without antimicrobial stewardship program (ASP) intervention, and rapid diagnostics (ADX in addition to conventional standard) with ASP intervention. Primary endpoints were time to adequate, to optimal and to step-down antimicrobial therapy. Secondary endpoints were antimicrobial consumption, in-hospital mortality, length of stay (LOS), and the incidence of Clostridioidesdifficile infection (CDI). RESULTS: Two hundred four patients (conventional diagnostics, n = 64; conventional diagnostics + ASP, n = 68; rapid diagnostics + ASP; n = 72) were evaluated. The use of ADX significantly decreased time from Gram stain to ID (median, 23 vs 2.2 hours, P < .001) and AST (median, 23 vs 7.4 hours, P < .001), from Gram stain to optimal therapy (median, 11 vs 7 hours, P = .024) and to step-down antimicrobial therapy (median, 27.8 vs 12 hours, P = .019). However, groups did not differ in antimicrobial consumption, duration of antimicrobial therapy, mortality, LOS, or incidence of CDI. CONCLUSIONS: Use of ADX significantly reduced time to ID and AST as well as time to optimal antimicrobial therapy but did not affect antimicrobial consumption and clinical outcome.
Authors: Alyssa B Christensen; Brent Footer; Tobias Pusch; Kim Heath; Maha Iqbal; Lian Wang; Gregory Tallman; Cameron Cover; Jennifer Marfori; Brian Kendall; Nick Stucky; Meagan Greckel; Ivor L Thomas; Katelynn Tran; Salena Yip; Margret Oethinger Journal: Open Forum Infect Dis Date: 2022-07-22 Impact factor: 4.423
Authors: Amira A Bhalodi; Shawn H MacVane; Bradley Ford; Dilek Ince; Patrick M Kinn; Kelly M Percival; Derek N Bremmer; Dustin R Carr; Thomas L Walsh; Micah M Bhatti; Samuel A Shelburne; Romney M Humphries; Kaleb Wolfe; Eric R Rosenbaum; Ryan K Dare; Johann Kolev; Meghan Madhusudhan; Michael A Ben-Aderet; Margie A Morgan Journal: Clin Infect Dis Date: 2022-08-25 Impact factor: 20.999