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Benefits of Adding a Rapid PCR-Based Blood Culture Identification Panel to an Established Antimicrobial Stewardship
Shawn H MacVane1, Frederick S Nolte2
1Department of Pharmacy, Medical University of South Carolina, Charleston, South Carolina, USA Division of Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina, USA.
Abstract:
Studies have demonstrated that the combination of antimicrobial stewardship programs (ASP) and rapid organism identification improves outcomes in bloodstream infections (BSI) but have not controlled for the incremental contribution of the individual components. Hospitalized adult patients with blood culture pathogens on a rapid, multiplex PCR-based blood culture identification panel (BCID) that included 19 bacterial species, 5 Candida spp., and 4 antimicrobial resistance genes were studied over sequential time periods in a pre-post quasiexperimental study in 3 groups in the following categories: conventional organism identification (controls), conventional organism identification with ASP (AS), and BCID with ASP (BCID). Clinical and economic outcomes were compared between groups. There were 783 patients with positive blood cultures; of those patients, 364 (115 control, 104 AS, and 145 BCID) met inclusion criteria. The time from blood culture collection to organism identification was shorter in the BCID group (17 h; P < 0.001) than in the control group (57 h) or the AS group (54 h). The BCID group had a shorter time to effective therapy (5 h; P < 0.001) than the control group (15 h) or AS group (13 h). The AS (57%) and BCID (52%) groups had higher rates of antimicrobial de-escalation than the control group (34%), with de-escalation occurring sooner in the BCID group (48 h; P = 0.034) than in the AS group (61 h) or the control group (63 h). No difference between the control group, AS group, and BCID group was seen with respect to mortality, 30-day readmission, intensive care unit length of stay (LOS), postculture LOS, or costs. In patients with BSI, ASP alone improved antimicrobial utilization. Addition of BCID to an established ASP shortened the time to effective therapy and further improved antimicrobial use compared to ASP alone, even in a setting of low antimicrobial resistance rates.
Insights
Antimicrobial stewardship programs (ASP) combined with rapid organism identification using multiplex PCR panels (BCID) improve bloodstream infection (BSI) treatment. BCID further shortens time to effective therapy and enhances antimicrobial use compared to ASP alone.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Health Services Research
Background:
- Bloodstream infections (BSI) require timely and appropriate antimicrobial therapy.
- Antimicrobial stewardship programs (ASP) aim to optimize antimicrobial use.
- Rapid organism identification methods, such as multiplex PCR-based blood culture identification panels (BCID), may enhance BSI management.
Purpose of the Study:
- To evaluate the independent and combined effects of ASP and BCID on clinical and economic outcomes in patients with BSI.
- To determine if BCID adds incremental benefit to an established ASP.
Main Methods:
- A pre-post quasiexperimental study design was used with three groups: controls (conventional identification), ASP alone, and BCID with ASP.
- Patients with positive blood cultures were analyzed, comparing time to organism identification, time to effective therapy, antimicrobial de-escalation rates, mortality, readmission, length of stay, and costs.
- A multiplex PCR panel (BCID) identifying 19 bacterial species, 5 Candida spp., and 4 antimicrobial resistance genes was utilized.
Main Results:
- The BCID group showed significantly shorter times to organism identification (17 h vs. 57 h/54 h) and effective therapy (5 h vs. 15 h/13 h) compared to control and ASP groups.
- Both ASP and BCID groups had higher rates of antimicrobial de-escalation than controls, with earlier de-escalation in the BCID group (48 h vs. 61 h/63 h).
- No significant differences were observed in mortality, 30-day readmission, ICU length of stay, postculture length of stay, or costs across the groups.
Conclusions:
- ASP alone improves antimicrobial utilization in BSI management.
- Adding BCID to an established ASP further shortens time to effective therapy and enhances antimicrobial use, even with low resistance rates.
- BCID provides incremental benefits in optimizing antimicrobial therapy for BSI when integrated with ASP.
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