The impact of a rapid molecular identification test on positive blood cultures from critically ill with bacteremia: A pre-post intervention study


Autoři: Alexia Verroken aff001;  Noémie Despas aff001;  Hector Rodriguez-Villalobos aff001;  Pierre-François Laterre aff002
Působiště autorů: Department of Microbiology, Cliniques Universitaires Saint-Luc – Université Catholique de Louvain, Brussels, Belgium aff001;  Intensive Care Department, Cliniques Universitaires Saint-Luc – Université Catholique de Louvain, Brussels, Belgium aff002
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223122

Souhrn

Objectives

Bloodstream infections in critically ill require a speeded-up microbiological diagnosis to improve clinical outcomes. In this pre-post intervention study, we evaluated how a molecular identification test directly performed on positive blood cultures of critically ill improves patient’s therapeutic management.

Methods

All adult patients staying at the intensive care unit (ICU) at the time of positive blood culture detection were study-eligible. In the 8-month pre-intervention period (P0), standard positive blood culture management was performed. In the 10-month intervention period (P1), a BioFire® FilmArray® blood culture identification (FA-BCID) test (bioMérieux) was additionally performed 24/7 at detection. The evaluated clinical outcome was time to optimal antimicrobial treatment of the bloodstream infection. FA-BCID microbiological test performances were also analysed.

Results

163 positive blood culture episodes were allocated to P0 and 166 to P1. After the withdrawal of episodes in accordance with defined exclusion criteria, outcome analysis was performed on 110 bloodstream infections both in P0 and P1. Time to optimal antimicrobial treatment in P0 was 14h41 compared to 4h39 in P1. FA-BCID test results led to a treatment adjustment in 35/110 (31.8%) P1 episodes including 26 where the adjustment was the optimal antimicrobial treatment. FA-BCID testing identified 96.2% of the on-panel microorganisms thereby covering 85.2% of our ICU-strain epidemiology. Time to identification with FA-BCID testing was calculated at 1h35. Resistance detection was in complete concordance with routine results. Considering 150 FA-BCID tests were initially performed in P1, 4,3 tests were required to have 1 test leading to an improved therapeutic outcome.

Conclusions

FA-BCID testing drastically reduced time to optimal antimicrobial treatment in critically ill with bloodstream infections.

Klíčová slova:

Antibiotics – Antimicrobials – Blood – Enterococcus faecalis – Intensive care units – Matrix-assisted laser desorption ionization time-of-flight mass spectrometry – Staphylococcus aureus – Bloodstream infections


Zdroje

1. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45: 486–552. doi: 10.1097/CCM.0000000000002255 28098591

2. Peker N, Couto N, Sinha B, Rossen JW. Diagnosis of bloodstream infections from positive blood cultures and directly from blood samples: recent developments in molecular approaches. Clin Microbiol Inf. 2018;24: 944–955.

3. Banerjee R, Teng CB, Cunningham SA, Ihde SM, Steckelberg JM, Moriarty JP, et al. Randomized trial of rapid multiplex polymerase chain reaction-based blood culture identification and susceptibility testing. Clin Infect Dis. 2015;61: 1071–1080. doi: 10.1093/cid/civ447 26197846

4. Roshdy G, Tran A, LeCroy N, Zeng D, Ou F-s, Daniels LM et al. Impact of a rapid microarray-based assay for identification of positive blood cultures for treatment optimization for patients with streptococcal and enterococcal bacteremia. J Clin Microbiol. 2015;53: 1411–1414. doi: 10.1128/JCM.00104-15 25673785

5. Pardo J, Klinker KP, Borgert SJ, Butler BM, Giglio PG, Rand KH. Clinical and economic impact of antimicrobial stewardship interventions with the FilmArray blood culture identification panel. Diag Microbiol Inf Dis. 2016;84: 159–164.

6. Walker T, Dumadag S, Lee JC, Lee SH, Bender JM, Abbott JC et al. Clinical impact of laboratory implementation of Verigene BC-GN microarray-based assay for detection of gram-negative bacteria in positive blood cultures. J Clin Microbiol. 2016;54: 1789–1796. doi: 10.1128/JCM.00376-16 27098961

7. Timbrook TT, Morton JB, McConeghy KW, Caffrey AR, Mylonakis E, LaPlanta KL. The effect of molecular rapid diagnostic testing on clinical outcomes in bloodstream infections: a systematic review and meta-analysis. Clin Infect Dis. 2017;64: 15–23. doi: 10.1093/cid/ciw649 27678085

8. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302: 2323–2329. doi: 10.1001/jama.2009.1754 19952319

9. Brooks D, Smith A, Young D, Fulton R, Booth MG. Mortality in intensive care: the impact of bacteremia and the utility of systemic inflammatory response syndrome. Am J Inf Control. 2016;44: 1291–1295.

10. Barnett AG, Page K, Campbell M, Martin E, Rashleigh-Rolls R, Haltin K, et al. The increased risks of death and extra lengths of hospital and ICU stay from hospital- acquired bloodstream infections: a case–control study. BMJ Open. 2013; 3:e003587. doi: 10.1136/bmjopen-2013-003587 24176795

11. Brunelli SM, Turenne W, Sibbel S, Hunt A, Pfaffle A. Clinical and economic burden of bloodstream infections in critical care patients with central venous catheters. J Crit Care. 2016;35: 69–74. doi: 10.1016/j.jcrc.2016.04.035 27481738

12. Verroken A, Defourny L, le Polain de Waroux O, Belkhir L, Laterre PF, Delmée Met al. Clinical impact of MALDI-TOF MS identification and rapid susceptibility testing on adequate antimicrobial treatment in sepsis with positive blood cultures. PLoS One. 2016; 11:e0156299. doi: 10.1371/journal.pone.0156299 27228001

13. Centers for Disease Control and Prevention [Internet]. Atlanta. National Healthcare Safety Network CDC/NHSN bloodstream infection event (central line-associated infection and non central-line associated bloodstream infection). [Updated 2016 January]. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf.

14. Rand KH, Delano JP. Direct identification of bacteria in positive blood cultures: comparison of two rapid methods, FilmArray and mass spectrometry. Diag Microbiol Inf Dis. 2014;79: 293–297.

15. Salimnia H, Fairfax MR, Lephart PR, Schreckenberger P, DesJarlais SM, Johnson JK et al. Evaluation of the FilmArray blood culture identification panel: results of a multicenter controlled trial. J Clin Microbiol. 2016;54: 687–698. doi: 10.1128/JCM.01679-15 26739158

16. European Centre for Disease Prevention and Control. Surveillance of antimicrobial resistance in Europe 2016; Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC 2017.

17. Forrest GN, Mehta S, Weekes E, Lincalis DP, Johnson JK, Venezia RA. Impact of rapid in situ hybridization testing on coagulase-negative staphylococci positive blood cultures. J Antimicrob Chemother. 2006;58: 154–158. doi: 10.1093/jac/dkl146 16636084


Článek vyšel v časopise

PLOS One


2019 Číslo 9

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Léčba bolesti v ordinaci praktického lékaře
nový kurz
Autoři: MUDr. PhDr. Zdeňka Nováková, Ph.D.

Revmatoidní artritida: včas a k cíli
Autoři: MUDr. Heřman Mann

Jistoty a nástrahy antikoagulační léčby aneb kardiolog - neurolog - farmakolog - nefrolog - právník diskutují
Autoři: doc. MUDr. Štěpán Havránek, Ph.D., prof. MUDr. Roman Herzig, Ph.D., doc. MUDr. Karel Urbánek, Ph.D., prim. MUDr. Jan Vachek, MUDr. et Mgr. Jolana Těšínová, Ph.D.

Léčba akutní pooperační bolesti
Autoři: doc. MUDr. Jiří Málek, CSc.

Nové antipsychotikum kariprazin v léčbě schizofrenie
Autoři: prof. MUDr. Cyril Höschl, DrSc., FRCPsych.

Všechny kurzy
Kurzy Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se