Antimicrobial Optimization after Implementation of a Rapid Multiplex PCR Based Diagnostic Test for Positive Blood Cultures at a Children's Hospital
Rapid multiplex PCR testing was recently FDA-approved for identification of pathogens directly from positive blood cultures (BCx). A potential benefit is more rapid optimization of antimicrobial therapy for bloodstream infection. We recently implemented this testing and examined the effect on antibiotic therapy in hospitalized children.
In February 2014, we implemented the BioFire Diagnostics FilmArray Blood Culture ID (BCID) panel for the identification of organisms from positive aerobic BCx. We provided formal education to clinicians and a handout with recommended empiric treatment for identified organisms based upon local antibiogram data. Automatic pages with BCID results were sent to the antimicrobial stewardship team on weekdays. We compared antimicrobial usage before and after the implementation in patients with positive BCx from January 1st, 2013 to April 30th, 2014. BCx positive within 7 days of a previous positive culture with the same organism in the same patient were considered part of the same episode. The primary endpoint was change in antimicrobial therapy (new initiation or discontinuation) within 24 hours of first positive BCx result called to the clinician. Secondary endpoints included antimicrobial discontinuations and initiations.
We identified a total of 744 positive BCx from 384 patients, accounting for 515 infection episodes during the pre-BCID period and 99 BCx in 70 patients, with 77 distinct infections during the BCID time period. BCID was run on 58 cultures in 57 unique patients. An antibiotic change was made within 24 hours of the first blood culture result in 242 of the 515 episodes (47%) in the pre BCID period and in 37 of the 77 episodes (48%) in the BCID period. At least one antibiotic was discontinued in 162 of 515 episodes (31%) in the pre BCID period and in 26 of 77 episodes (34%) in the BCID period. At least one antibiotic was initiated in 185 of 515 episodes (36%) in the pre BCID group compared to 32 of 77 (42%) in the BCID period.
In this early analysis, antimicrobial prescribing was similar for children with bloodstream infection before and after implementation of BCID testing. With improved education and ASP intervention, appropriate antimicrobial therapy may be achieved earlier.
M. Lahart, None
E. Doby, None
A. J. Blaschke, BioFire Diagnostics, LLC: Collaborator and Scientific Advisor, Co-Investigator on NIH grant; BioFire Principal Investigator, Consulting fee and Licensing agreement or royalty