Impact of a rapid multiplex polymerase chain reaction blood culture identification technology on outcomes in patients with vancomycin-resistant Enterococcal bacteremia

• Published in: Infectious diseases (London, England) Vol. 48; no. 10; pp. 732 - 737
• Main Authors: MacVane, Shawn H., Hurst, John M., Boger, M. Sean, Gnann, John W.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 02.10.2016
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Bacteremia; Bacteremia - diagnosis; Bacteremia - drug therapy; Bacteremia - microbiology; Blood Culture - methods; Enterococcus; Female; Gram-Positive Bacterial Infections - diagnosis; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - microbiology; Humans; Male; Middle Aged; Multiplex Polymerase Chain Reaction - methods; Non-Randomized Controlled Trials as Topic; outcomes; rapid diagnostics; Time Factors; Treatment Outcome; Vancomycin-Resistant Enterococci - genetics; Vancomycin-Resistant Enterococci - growth & development; Vancomycin-Resistant Enterococci - isolation & purification; Young Adult; Enterococcus; rapid diagnostics; outcomes; Bacteremia
• ISSN: 2374-4235; 2374-4243
• DOI: 10.1080/23744235.2016.1185533

Background: Early appropriate antibiotic selection is associated with favorable clinical outcomes. We evaluated the clinical impact of rapid detection of vancomycin-resistant Enterococcal bacteremia (VREB) by the FilmArray blood culture identification (BCID) panel coupled with antimicrobial stewardship program (ASP) interventions. Methods: Hospitalized adult patients with VREB identified by conventional methods (CM) were compared to patients with VREB identified by BCID. Real time alerts of BCID results were provided to the ASP for intervention. Outcomes were compared between groups. Results: Sixty-eight patients with VREB were included (CM, n = 45; BCID, n = 23). No significant differences in demographics, pre-existing conditions, or clinical characteristics were observed. Significant reductions were demonstrated between CM and BCID groups in median hours to organism identification (47.7 versus 18.2, p < 0.001), to identification of vancomycin resistance from time of culture positivity (50.1 versus 1.2, p < 0.001), and time to effective therapy (50.3 versus 20.8, p < 0.001). Differences between CM and BCID did not reach statistical significance for mortality (35.6% versus 26.1%), 30-day readmission rate (31.0% versus 17.6%), intensive care length of stay [LOS] (8.0 versus 7.0 days), post-culture LOS (14.6 versus 14.1 days) or median hospital costs per patient ($95,826 versus $53,195). Conclusions: In patients with VREB, rapid organism and resistance detection by the BCID panel with ASP intervention significantly reduced time to initiation of effective therapy by over 24 hours. Non-significant improvements in clinical outcomes were observed. Additional studies are needed to determine the full implications of BCID technology on patient outcome.