998. Clinical Impact of Multiplex PCR for Rapid Identification of Staphylococcus Aureus Bacteremia in Hospitalized Pediatric Patients
Session: Poster Abstract Session: Diagnostic Microbiology: Staphylococci
Friday, October 9, 2015
Room: Poster Hall
Posters
  • Presentation 998 - S aureus bacteremia.pdf (505.0 kB)
  • Background:

    S. aureus is a leading cause of invasive disease in children and for both MSSA and MRSA bacteremia, timely initiation of therapy is the critical factor in decreasing morbidity and mortality. Rapid multiplex PCR testing in blood cultures provides faster identification and detection of gene for methicillin-resistance in S. aureus isolates compared to traditional laboratory techniques. Hence, we evaluated the impact of management in pediatric patients with S. aureus bacteremia after implementation of the FilmArray blood culture identification (BCID) panel (BioFire, Salt Lake City, UT). 

    Methods:

    The FilmArray BCID panel was implemented in July 2014, and as per institutional protocol, all patients with a positive blood culture for S. aureus require a formal infectious diseases (ID) consult. All patients with S. aureus bacteremia one year before implementation of the FilmArray BCID panel and in the subsequent 6 months after implementation were evaluated. 

    Results:

    The total cases of S. aureus bacteremia were 57 and 23, pre and post intervention, and MSSA predominated. The median time to identification of S. aureus from blood cultures decreased from 19 h before to 1 h after the FilmArray BCID panel was implemented. This was associated with a shorter time to initiation of b-lactams and decreased exposure to vancomycin for patients with MSSA bacteremia in the post intervention period.

     

    Pre intervention

    n = 57

    Post intervention

    n= 23

    P

    Median age, mo., [IQR]

    70 [9-132]

    84 [40-172]

    0.15

    Gender

    • Female, n (%)
    • Male, n (%)

    19 (33)

    38 (67)

    9 (39)

    14 (61)

    0.62

    Sepsis at presentation, n (%)

    37 (65)

    11 (48)

    0.16

    Isolate susceptibility

    • MSSA, n (%)
    • MRSA, n (%)

    44 (79)

    12 (21)

    21 (95)

    1 (5)

    0.10

    Median time to identification of S. aureus, h, [IQR]

    19.0 [17.2-21.7]

    1.0 [0.9-1.2]

    <0.0001

    MSSA isolates

    • Median time to initiation of b-lactam, h, [IQR]
    • Median exposure to vancomycin, h [IQR]

    7.0 [2.1-10.8]

    5.0 [0.4-15.2]

    3.0 [2.0-4.0]

    0.2 [-1.1-4.3]

    0.04

    0.12

    Conclusion:

    Rapid multiplex PCR testing resulted in a shorter time to initiation of appropriate therapy and decreased patient exposure to vancomycin in those with MSSA bacteremia. We are in the process of evaluating clinical outcomes including time to ID consultation and infection source control associated with rapid PCR detection.

    Sanet Torres-Torres, MD1,2, Jennifer Goldman, MD, MS3, Angela Myers, MD, MPH, FPIDS4, Dwight Yin, MD, MPH1,2, Rangaraj Selvarangan, PhD5 and Mary Anne Jackson, MD, FIDSA, FPIDS6, (1)Pediatric Infectious Diseases, Children's Mercy Hospital and Clinics, Kansas City, MO, (2)Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, (3)Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, MO, (4)Children's Mercy Hospital, Kansas City and University of Missouri-Kansas City School of Medicine, Kansas City, MO, (5)Children's Mercy Hospital, Kansas City, MO, (6)Pediatrics, Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, MO

    Disclosures:

    S. Torres-Torres, None

    J. Goldman, None

    A. Myers, None

    D. Yin, None

    R. Selvarangan, None

    M. A. Jackson, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.