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The impact of a rapid molecular identification test on positive blood cultures from critically ill with bacteremia: A pre-post intervention study.
- Source :
-
PloS one [PLoS One] 2019 Sep 26; Vol. 14 (9), pp. e0223122. Date of Electronic Publication: 2019 Sep 26 (Print Publication: 2019). - Publication Year :
- 2019
-
Abstract
- 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.<br />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.<br />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.<br />Conclusions: FA-BCID testing drastically reduced time to optimal antimicrobial treatment in critically ill with bloodstream infections.<br />Competing Interests: This work was funded by BioFire Diagnostics (Salt Lake City, Utah) (https://www.biomerieux-usa.com/clinical/biofire-film-array). BioFire Diagnostics supplied 2 FilmArray systems as well as the FA-BCID tests to perform the study. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The authors have no other relevant declarations relating to employment, consultancy, patents, products in development, marketed products.
- Subjects :
- Adult
Aged
Anti-Bacterial Agents pharmacology
Bacteremia diagnosis
Bacteremia microbiology
Bacteria drug effects
Blood Culture instrumentation
Critical Illness therapy
Drug Resistance, Bacterial
Female
Follow-Up Studies
Humans
Male
Microbial Sensitivity Tests statistics & numerical data
Middle Aged
Molecular Diagnostic Techniques instrumentation
Molecular Diagnostic Techniques statistics & numerical data
Program Evaluation
Time Factors
Treatment Outcome
Anti-Bacterial Agents therapeutic use
Bacteremia drug therapy
Bacteria isolation & purification
Blood Culture statistics & numerical data
Molecular Diagnostic Techniques methods
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 14
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 31557233
- Full Text :
- https://doi.org/10.1371/journal.pone.0223122