Bloodstream infections (BSI) are associated with significant morbidity and mortality. Molecular rapid diagnostic testing (mRDT) has been reported to improve clinical outcomes in BSI, but these reported benefits have been inconsistent. The objective of this meta-analysis was to evaluate the utility of mRDT in improving clinical outcomes.
Pubmed, Web of science, and EMBASE were searched from inception to April 2016 for BSI studies in English comparing clinical outcomes by mRDT and conventional microbiology methods. Keywords related to BSI, mRDT, and clinical outcomes were used. Additionally, a manual search of the included articles references was conducted. Abstracts from IDWeek, ICAAC, and ESCMID were also reviewed. Outcomes included mortality by studies with and without antimicrobial stewardship (AMS), mortality by organism, time to effective therapy, and length of stay (LOS). Data analyses were performed using a random effects model to estimate pooled odds ratios (OR) and 95% confidence intervals (CI).
Figure 1. Mortality with mRDT vs conventional
Note. mRDT - Molecular rapid diagnostic testing; * - Conference proceedings
We identified 7960 total documents, of which 1836 were duplicates and 6124 were removed during the title and abstract review. After full text review, twenty-eight studies met inclusion criteria. Risk of mortality was significantly decreased with mRDT as compared to conventional microbiology methods (OR 0.63, CI 0.53 to 0.76). Mortality risk decreases were similar among AMS (OR 0.64, CI 0.51 to 0.79) and non-AMS studies with mRDT (OR 0.64, CI 0.42 to 0.97). Significant decreases in mortality risk were seen in gram-positive and gram-negative organisms (OR 0.74, CI 0.57 to 0.95; OR 0.46, CI 0.31 to 0.68) but not yeast (OR 0.82, CI 0.46 to 1.45). Time to effective therapy decreased by a weighted mean difference (WMD) of 6.93 hours (CI -12.95 to -0.91). LOS decreased by a WMD of 2.33 days (CI -3.77 to -0.89).
mRDT is associated with decreased risk of mortality, particularly in bacteremic patients. Time to effective therapy and LOS were also improved. AMS studies contributed the majority of the data in the quantitative analysis.
A. Caffrey, Pfizer: Research , Research grant
Merck (Cubist): Research , Research grant
K. Laplante, Merck (Cubist): Consultant and Scientific Advisor , Research support
Pfizer: Consultant and Scientific Advisor , Research support
Allergan (Forest): Consultant and Scientific Advisor , Research support
The Medicines Company: Consultant and Scientific Advisor , Research support
Melinta: Consultant and Scientific Advisor , Research support
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