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

Autor: Alexia Verroken, Noémie Despas, Hector Rodriguez-Villalobos, Pierre-François Laterre
Přispěvatelé: UCL - SSS/IREC/MBLG - Pôle de Microbiologie médicale, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service de microbiologie, UCL - (SLuc) Service de soins intensifs
Rok vydání: 2019
Předmět:
Male
0301 basic medicine
Time Factors
Physiology
Staphylococcus
Antibiotics
Bacteremia
Drug resistance
Pathology and Laboratory Medicine
Mass Spectrometry
Analytical Chemistry
law.invention
Spectrum Analysis Techniques
0302 clinical medicine
law
Epidemiology
Medicine and Health Sciences
Medicine
Blood culture
Staphylococcus Aureus
030212 general & internal medicine
Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry
Multidisciplinary
medicine.diagnostic_test
Antimicrobials
Drugs
Hematology
Middle Aged
Intensive care unit
Hospitals
Anti-Bacterial Agents
Body Fluids
Bacterial Pathogens
Chemistry
Intensive Care Units
Treatment Outcome
Blood
Molecular Diagnostic Techniques
Medical Microbiology
Physical Sciences
Female
Anatomy
Pathogens
Research Article
Adult
medicine.medical_specialty
medicine.drug_class
Science
Critical Illness
030106 microbiology
Microbial Sensitivity Tests
Enterococcus Faecalis
Research and Analysis Methods
Microbiology
Post-intervention
03 medical and health sciences
Microbial Control
Internal medicine
Drug Resistance
Bacterial
Humans
Microbial Pathogens
Aged
Pharmacology
Bacteria
business.industry
Organisms
Biology and Life Sciences
Bloodstream Infections
medicine.disease
Health Care
Clinical trial
Blood Culture
Health Care Facilities
business
Enterococcus
Follow-Up Studies
Program Evaluation
Zdroj: PloS one, Vol. 14, no. 9, p. e0223122 [1-12] (2019)
PLoS ONE
PLoS ONE, Vol 14, Iss 9, p e0223122 (2019)
ISSN: 1932-6203
Popis: 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 (bioMerieux) 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.
Databáze: OpenAIRE
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