Improving outcomes and antibiotic stewardship (IOAS) for patients with Gram-positive bloodstream infections through use of rapid testing: a quasi-experimental multicentre study of the Accelerate PhenoTest™ BC Kit

Shawn H MacVane; Amira A Bhalodi; Ryan K Dare; Eric R Rosenbaum; Kaleb Wolfe; Bradley Ford; Dilek Ince; Patrick Kinn; Kelly M Percival; Romney M Humphries

doi:10.1093/jac/dkab165

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Improving outcomes and antibiotic stewardship (IOAS) for patients with Gram-positive bloodstream infections through use of rapid testing: a quasi-experimental multicentre study of the Accelerate PhenoTest™ BC Kit

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Improving outcomes and antibiotic stewardship (IOAS) for patients with Gram-positive bloodstream infections through use of rapid testing: a quasi-experimental multicentre study of the Accelerate PhenoTest™ BC Kit

Shawn H MacVane, Amira A Bhalodi, Ryan K Dare, Eric R Rosenbaum, Kaleb Wolfe, Bradley Ford, Dilek Ince, Patrick Kinn, Kelly M Percival and Romney M Humphries

Journal of antimicrobial chemotherapy, Vol.76(9), pp.2453-2463

05/22/2021

DOI: 10.1093/jac/dkab165

PMCID: PMC8361360

PMID: 34021752

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Abstract

Abstract Background Data from the Improving Outcomes and Antibiotic Stewardship for Patients with Bloodstream Infections: Accelerate PhenoTest™ BC Kit (AXDX) Registry Study were analysed to determine the impact of rapid organism identification and antimicrobial susceptibility testing (AST) for Gram-positive bacteraemia. Patients and methods This multicentre, quasi-experimental study evaluated clinical and antimicrobial stewardship metrics following the implementation of AXDX. Data from hospitalized patients with bacteraemia were compared between groups, one that underwent testing on AXDX (post-AXDX) and one that underwent traditional identification and AST (pre-AXDX). An analysis of patients with Gram-positive bacteraemia was performed. The primary outcome was time to optimal therapy (TTOT). Secondary outcomes included time to first antibiotic modification (overall and Gram-positive), duration of unnecessary MRSA coverage, incidence of adverse events, length of stay and mortality. Results A total of 219 (109 pre-AXDX, 110 post-AXDX) patients with Gram-positive bacteraemia were included. Median TTOT was 36.3 h (IQR, 16.9–56.7) in the pre-AXDX group and 20.4 h (IQR, 7.5–36.7) in the post-AXDX group (P = 0.01). Compared with pre-AXDX, median time to first antibiotic modification (29.1 versus 15.9 h; P = 0.002), time to first Gram-positive antibiotic modification (33.2 versus 17.2 h; P = 0.003) and median duration of unnecessary MRSA coverage (58.4 versus 29.7 h; P = 0.04) were reduced post-AXDX. A trend towards decreased acute kidney injury (24% versus 13%; P = 0.06) was observed in the post-AXDX group. Groups did not differ in other secondary outcomes. Conclusions Implementation of AXDX testing for patients with Gram-positive bacteraemia shortened the TTOT and reduced unnecessary antibiotic exposure due to faster antibiotic modifications.

Details

Title: Subtitle: Improving outcomes and antibiotic stewardship (IOAS) for patients with Gram-positive bloodstream infections through use of rapid testing: a quasi-experimental multicentre study of the Accelerate PhenoTest™ BC Kit
Creators: Shawn H MacVane - Accelerate Diagnostics, Inc, Tucson, AZ, USA.
Amira A Bhalodi - Accelerate Diagnostics, Inc, Tucson, AZ, USA.
Ryan K Dare - University of Arkansas for Medical Sciences
Eric R Rosenbaum - University of Arkansas for Medical Sciences
Kaleb Wolfe - University of Arkansas for Medical Sciences
Bradley Ford - University of Iowa Hospitals and Clinics
Dilek Ince - University of Iowa
Patrick Kinn - University of Iowa Hospitals and Clinics
Kelly M Percival - University of Iowa Hospitals and Clinics
Romney M Humphries - University Medical Center
Resource Type: Journal article
Publication Details: Journal of antimicrobial chemotherapy, Vol.76(9), pp.2453-2463
DOI: 10.1093/jac/dkab165
PMID: 34021752
PMCID: PMC8361360
NLM abbreviation: J Antimicrob Chemother
ISSN: 0305-7453
eISSN: 1460-2091
Grant note: name: Accelerate Diagnostics, Inc
Language: English
Date published: 05/22/2021
Academic Unit: Infectious Diseases; Pathology; Internal Medicine
Record Identifier: 9984186285302771

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