Do rapid diagnostic methods improve antibiotic prescribing in paediatric bacteraemia?

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Clinical Pharmacy

Background:

• Rapid diagnostics, such as matrix-assisted laser desorption ionisation time-of-flight and GeneXpert, offer potential for timely antibiotic prescribing in paediatric bacteraemia.
• Optimizing antibiotic use is crucial for improving patient outcomes and combating antimicrobial resistance.

Purpose of the Study:

• To evaluate the impact of rapid diagnostics on the timeliness of effective and optimal antibiotic prescribing in paediatric patients with bacteraemia.
• To assess the effect of rapid diagnostics on clinical outcomes, including length of stay and mortality.

Main Methods:

• A single-centre retrospective cohort study compared paediatric bacteraemia cases before and after the implementation of rapid diagnostics.
• Primary outcomes included the proportion and median time to effective and optimal antibiotic therapy.
• Secondary outcomes assessed hospital length of stay, ICU admissions, and all-cause mortality.

Main Results:

• No significant difference was observed in the median time to effective (1.8 vs. 2.3 hours) or optimal antibiotic therapy (39.1 vs. 44.4 hours) between the rapid diagnostics and control cohorts.
• The proportion of patients receiving effective or optimal therapy, length of stay, ICU admissions, and all-cause mortality did not differ significantly between the groups.
• A total of 255 cases were analyzed (129 pre-implementation, 126 post-implementation).

Conclusions:

• Implementing rapid diagnostics alone did not improve antibiotic prescribing timeliness or clinical outcomes in paediatric bacteraemia.
• Effective utilization of rapid diagnostics necessitates integration with active antimicrobial stewardship interventions, such as real-time guidance for de-escalation or modification of therapy.