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 |
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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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