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Do rapid diagnostic methods improve antibiotic prescribing in paediatric bacteraemia?

Amy K Faugno1,2, Alexandra Y Laidman1,3, Jonathan D Perez Martinez1,4

  • 1School of Medicine, University of Western Australia, Perth, Western Australia, Australia.

Journal of Paediatrics and Child Health
|November 16, 2020
PubMed

Insights

Rapid diagnostics for bloodstream infections in children did not improve antibiotic prescribing times. Effective use requires integration with antimicrobial stewardship programs for better patient outcomes.

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.
Abstract

Keywords:
GeneXpertantimicrobial therapybacteraemiamatrix-assisted laser desorption ionisation time-of-flightpaediatrics

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