1869. Impact of rapid identification of positive blood cultures by Verigene system on antibiotic prescription: prospective study of community-onset bacteremia in a tertiary hospital in Japan
Session: Poster Abstract Session: Antibiotic Stewardship: Diagnostics
Saturday, October 29, 2016
Room: Poster Hall

Background: Rapid identification of positive blood cultures is important for the rapid initiation of optimal treatment of septic patients and enhancing antimicrobial stewardship programs (ASP). The utility of automated, microarray-based rapid identification systems has been reported; however, its effect on antibiotic prescription against community-onset bacteremia (COB) remains unclear.

Methods: We prospectively enrolled 185 episodes of COB in 177 patients between August 2014 and December 2015. Episodes of bacteremia due to Gram-positive bacteria (GP) and Gram-negative bacteria (GN) in the same patient were counted separately. COB was defined as bacteremia occurring within 72 h of admission. For GP bacteremia, only patients with ≥ 2 sets of positive blood cultures were included to exclude contamination episode. The primary study objective was to evaluate the rates of antibiotic prescription change within 24 h of rapid identification by Verigene system. Antibiotic prescription changes included switching to other antibiotics and discontinuation of antibiotics initially started.

Results: The median age of the subjects was 72 years (IQR: 62–82) and 103 (58%) were male. Bacteremia due to GN included 144 (78%) episodes, and GP included 41 (22%) episodes. Antibiotic prescriptions changes within 24 h were 52 (28%) after the Verigene test and 67 (36%) after conventional identification. Prescription changes after Verigene identification were more frequent in GP (17 [42%]) than in GN (35 [24%]) (p = 0.048); however, the rates were similar between GP and GN after conventional identification (15 [37%], 52 [36%], respectively). Bacterial identification agreement between the 2 tests was high (GP: 40/41[98%], GN: 142/144 [99%]). The Verigene test correctly predicted all antimicrobial resistance (mecA: MRSA [2/2], MRSE [1/1], CTX-M: ESBL E. coli [13/13], ESBL K. pneumoniae [1/1]). Hours from the initiation of incubation and reporting of the results of the Verigene system and conventional method were 28.3 h (IQR: 25.8–43.4) and 90.6 h (68.3–118.4), respectively.

Conclusion: In a community-onset bacteremia population, we observed a high rate of antibiotic prescription changes after the Verigene test, which was more prominent in GP than GN. The Verigene system is a strong asset for ASP in this population.

 

Kayoko Hayakawa, M.D., Ph.D.1, Kazuhisa Mezaki, M. T.2, Kei Yamamoto, M.D.1, Yoshikazu Mutoh, M.D1, Motoyuki Tsuboi, M.D.1, Takehiro Hashimoto, M.D.1, Yuichi Katanami, M.D.1, Satoshi Kutsuna, M.D., Ph.D.1, Nozomi Takeshita, M.D., Ph.D.1, Masao Kobayakawa, MD2 and Norio Ohmagari, M.D., M.Sc., Ph.D.1, (1)Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan, (2)National Center for Global Health and Medicine, Tokyo, Japan

Disclosures:

K. Hayakawa, None

K. Mezaki, None

K. Yamamoto, None

Y. Mutoh, None

M. Tsuboi, None

T. Hashimoto, None

Y. Katanami, None

S. Kutsuna, None

N. Takeshita, None

M. Kobayakawa, None

N. Ohmagari, None

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