On April 29, 2014, the BioFire FilmArray Blood Culture Identification (BCID) panel was implemented at our hospital to provide rapid identification of pathogens from blood cultures. The BCID panel is a multiplex PCR which identifies 21 pathogens and methicillin (mecA) resistance. Our Antimicrobial Stewardship Program (ASP) team reviews usage of antimicrobials (AMs) and provides recommendations. The objective of this study was to assess the impact of the BCID panel on antibiotic utilization in patients with positive blood cultures.
We conducted a pre-post quasi-experimental study to measure the impact of the BCID panel on time to appropriate antibiotic therapy in patients with Staphylococcal bacteremia. Microbiological and antibiotic prescribing data from April 1, 2013 to March 30, 2015 were analyzed. Results for all positive blood cultures for methicillin susceptible and resistant Staphylococcus aureus (MSSA and MRSA) and coagulase negative staphylococci (CoNS) were included. Patients treated for CoNS infections and those with polymicrobial infections were excluded. Appropriate antibiotics were defined as antistaphylococcal beta lactams (MSSA) or vancomycin (MRSA). For CoNS appropriate antibiotic was defined as discontinuation of vancomycin or other broad spectrum Gram positive agents. SPSS version 22 was used for our statistical analysis.
A total of 151 episodes of bacteremia were included in the final analysis: 46 S. aureus, (26 pre and 20 post); 105 CoNS, (53 pre and 52 post). Five patients had MRSA bacteremia in the pre period and 2 in the post group. For S. aureus, we found a statistically significant difference in the median time to appropriate therapy between the pre and post groups (46 hours versus 16 hours, p<0.001). There was no difference between groups when adjusting for the presence of a central line, comorbidity or gender.
For patients with CoNS bacteremia, vancomycin was less likely to be initiated in the post group (OR 2.26, CI 1.04-4.96). There was no difference in the median time to discontinuation of vancomycin between the groups.
After implementation of the BCID panel, time to appropriate antibiotics was significantly shorter for S. aureus. Patients with CoNS were less likely to receive vancomycin. Rapid detection of organisms in blood cultures leads to more effective AM use.
S. Chan, None
J. Hossain, None
L. Marek, None