Predictive Value of Direct Disk Diffusion Testing from Positive Blood Cultures in a Children’s Hospital and Its Utility in Antimicrobial Stewardship
| Autor: | Shun Rao, Al Ozonoff, Timothy J. Savage, Thomas J. Sandora, Jill Joerger, Alexander J. McAdam |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty medicine.drug_class 030106 microbiology Antibiotics Bacteremia Microbial Sensitivity Tests medicine.disease_cause law.invention Antimicrobial Stewardship 03 medical and health sciences 0302 clinical medicine law Internal medicine medicine Humans Antimicrobial stewardship 030212 general & internal medicine Child Retrospective Studies business.industry Bacteriology Retrospective cohort study Hospitals Pediatric equipment and supplies medicine.disease Confidence interval Anti-Bacterial Agents Gram staining Blood Culture Staphylococcus aureus Ceftriaxone business medicine.drug |
| Zdroj: | J Clin Microbiol |
| ISSN: | 1098-660X 0095-1137 |
| DOI: | 10.1128/jcm.02445-20 |
| Popis: | Background Accurate and early susceptibility results could reduce overuse of broad-spectrum antibiotics for empiric treatment of bacteremia. Direct disk diffusion testing (dDD) using non-standardized inocula directly from blood cultures could facilitate earlier narrowing of antibiotics. Methods To determine the predictive value of dDD compared with standardized antimicrobial susceptibility testing (AST), we performed a retrospective cohort study of 582 blood cultures from 495 pediatric patients with bacteremia. Positive and negative predictive value (PPV: number of isolates susceptible by both dDD and AST divided by the total number of isolates susceptible by dDD; NPV: number of isolates not susceptible [either intermediate or resistant] by both dDD and AST divided by the total number of isolates not susceptible by dDD), sensitivity, specificity, and 95% confidence interval were calculated for each bacterium-antibiotic combination. We evaluated the Antibiotic Spectrum Index of prescribed antibiotics to assess change in antibiotic prescribing after availability of Gram stain, dDD, and AST results. Results dDD results were available a median of 21 hours before AST results. dDD had PPVs of ≥96% for most organism-antibiotic pairs, including 100% (CI 96-100%) for Staphylococcus aureus and oxacillin and 99% (CI 93%-100%) for Enterobacterales and ceftriaxone. NPVs of dDD were variable and frequently lower than PPV. Very major errors and major errors occurred in 31/5454 (0.6%) and 231/5454 (4.2%) organism-antibiotic combinations, respectively. Antibiotics were narrowed in 30% of cases after dDD result and a further 25% of cases after AST result. Conclusions dDD is highly predictive of susceptibility for many common organism-antibiotic combinations and provides actionable information one day earlier than standard susceptibility approaches. dDD has the potential to facilitate earlier de-escalation to narrow-spectrum antibiotic treatment. |
| Databáze: | OpenAIRE |
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