Program Schedule

171
Impact of Rapid Bloodstream Pathogen Identification in Hospitalized Patients

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Rapid identification of blood stream infection (BSI) pathogens by polymerase chain reaction (PCR) may reduce time to effective and optimal antibiotic use and improve patient outcomes.  We sought to evaluate the impact of a novel PCR system, the FilmArray Blood Culture ID (BCID) Panel (BioFire, Salt Lake City, UT). The BCID  is performed directly on a positive blood culture, has 27 PCR targets (20 pathogen specific, 4 genus level, and 3 resistance genes), and takes < 2 hours.

Methods: A case-control study included hospitalized patients with clinically significant BSI identified by traditional cultures with BCID (BG, cases, 11/13-4/14) or without BCID (TG, controls, 1/13-9/13). Prior to BCID introduction stewardship-driven guidelines for interpretation were widely distributed, but antibiotic management was dictated by primary teams. Time from blood culture draw to effective (antimicrobial active against the pathogen) and optimal (most narrow spectrum effective therapy) therapy were the primary outcomes.

Results: Fifty five subjects each in the BG and TG groups were similar in age, comorbidity, Charleson and Pitt bacteremia scores, critical care support needs, infectious disease involvement, and immunosuppressed status.  Common infection sources were central venous catheters (37.6%), genitourinary (16.5%), intra-abdominal (13.8%), and skin/bone (13.8%). Frequent BSI pathogens were E. coli (19.7%), S. aureus (16.4%), and Klebsiella species (9.8%) with 10.9% polymicrobial. Nosocomial infections were more common in the BG (41.8% vs. 24.1%, P=.02) and healthcare-associated infections in TG (57.4% vs. 30.9%, P=.02).

Outcome (*=mean)

BG (Std Dev) N=55

TG (Std Dev) N=55

P

Time to Effective Therapy, h*

14.9 (26.0)

14.3 (22.9)

.91

Time to Optimal Therapy, h*

47.4 (36.0)

58.6 (37.7)

.10

30-day Mortality, %

10.9

18.2

.42

Clinical Resolution, %

80

74.6

.65

Readmission, %

25.5

23.6

1.00

Days of Therapy*

26.2 (25.4)

26.2 (41.8)

.10

Length of Stay*

16.2 (12.4)

15.2 (24.1)

.03

Conclusion: Numerical improvements in time to optimal therapy, 30-day mortality, and clinical resolution were noted but not significant. The analysis was underpowered, but it is likely that clinicians are not changing antibiotic prescribing in response to BCID data. The BCID results should be paired with an antimicrobial stewardship intervention to improve its impact.

Matthew Maslonka, MD1, Alison G. Freifeld, MD1, Mark E. Rupp, MD1, Devon Greer, PharmD2, Robbe Peetz, PA1, Elizabeth Lyden, MS3, Paul D. Fey, PhD4 and Trevor C. Van Schooneveld, MD1, (1)Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, (2)Pharmacy and Nutrition, Nebraska Medical Center, Omaha, NE, (3)College of Public Health, University of Nebraska Medical Center, Omaha, NE, (4)Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE

Disclosures:

M. Maslonka, None

A. G. Freifeld, None

M. E. Rupp, 3M: Consultant and Grant Investigator, Consulting fee and Research grant

D. Greer, None

R. Peetz, None

E. Lyden, None

P. D. Fey, None

T. C. Van Schooneveld, None

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