1758. Impact of Accelerate PhenoTM Rapid Blood Culture Detection System on Laboratory and Clinical Outcomes in Bacteremic Patients
Session: Oral Abstract Session: Diagnostics Making a Difference
Saturday, October 6, 2018: 11:00 AM
Room: S 158

Background:

Molecular based automated systems for the rapid diagnosis of bacterial infections have potential to improve patient care. The Accelerate PhenoTM blood culture detection system (ACCEL) is an FDA approved platform that allows for identification (ID) and antimicrobial susceptibility testing (AST) 8 hours following growth in routine culture.

Methods:

This is a single center retrospective chart review of bacteremic adult inpatients before and after implementation of ACCEL. Laboratory and clinical data were collected Feb-Mar 2018 (intervention) and compared to a Jan-Apr 2017 historical cohort (standard of care). Standard of care ID and AST were performed using VITEK® MS (MALDI-TOF MS) and VITEK®2, respectively. An active antimicrobial stewardship program was in place during both study periods. Patients with polymicrobial cultures, off-panel isolates, previous positive culture, or who were discharged prior to final AST report were excluded. Primary outcome was length of stay (LOS). Secondary outcomes were inpatient antibiotic duration of therapy (DOT) and time to optimal therapy (TTOT). Nonparametric unadjusted analyses were performed due to non-normal distributions. Statistics were performed using SAS 9.4.

Results:

118 (83%) of the 143 positive cultures performed on ACCEL during intervention were identified as on-panel organisms. 75 (64%) of these 118 cultures and 79 (70%) of 113 reviewed standard of care cultures met inclusion criteria. Patient comorbidities (p=NS), MEWS severity score (p=0.10), source of bacteremia (p=NS), and pathogen detected (p=0.30) were similar between cohorts. Time from collection to ID (28.2 ± 12.7h vs 53.8 ± 20.9h; p<0.001) and AST (31.9 ± 11h vs 71.8 ± 20h; p<0.001) were shorter in the intervention arm.

 

Clinical Outcomes

Standard of Care (Mean ± SD)

 N  = 79

Intervention (Mean ± SD)

N =75

p-value

 LOS (days)

12.1  (11.9)

9.1 (7.6)

0.03

 TTOT (hours)

73.5 (50.2)

37.5 (32.7)

<0.001

 Total Antibiotic DOT (days)

9.0 (7.5)

7.0 (4.6)

0.05

 Meropenem DOT (days)

6.6 (3.7)

3.7 (2.1)

0.03

Conclusion:

Compared to standard of care, ACCEL shortens laboratory turn-around-time and improves clinical outcomes. Use of this system has resulted in decreased mean antibiotic DOT, TTOT, and LOS. Further studies are needed to verify these findings.    

 

Ryan Dare, MD, MS1, Kelsey McCain, PharmD2, Katherine Lusardi, PharmD, BCPS-AQ ID2, Kay Daniels, BS3, Jacob Painter, PharmD, MBA, PhD4, Mrinmayee Lakkad, MS4, Nicole Emery, BS M(ASCP)5, Eric Rosenbaum, MD, MPH5 and J Ryan Bariola, MD6, (1)Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, AR, (2)Hospital Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, (3)College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, (4)Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, (5)Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, (6)Division of Infectious Diseases, University of PIttsburgh Medical Center, Pittsburgh, PA

Disclosures:

R. Dare, None

K. McCain, None

K. Lusardi, None

K. Daniels, None

J. Painter, None

M. Lakkad, None

N. Emery, None

E. Rosenbaum, None

J. R. Bariola, None

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