The hypothetical impact of Accelerate Pheno™ system on time to effective therapy and time to definitive therapy in an institution with an established antimicrobial stewardship programme currently utilizing rapid genotypic organism/resistance marker identification.
Adult
Aged
Anti-Bacterial Agents
/ pharmacology
Antimicrobial Stewardship
/ methods
Blood Culture
/ statistics & numerical data
Drug Resistance, Multiple, Bacterial
Female
Genotype
Gram-Negative Bacteria
/ drug effects
Gram-Negative Bacterial Infections
/ diagnosis
Humans
In Situ Hybridization, Fluorescence
/ methods
Male
Microbial Sensitivity Tests
/ methods
Middle Aged
Retrospective Studies
Sepsis
/ diagnosis
Time-to-Treatment
/ statistics & numerical data
Journal
The Journal of antimicrobial chemotherapy
ISSN: 1460-2091
Titre abrégé: J Antimicrob Chemother
Pays: England
ID NLM: 7513617
Informations de publication
Date de publication:
01 01 2019
01 01 2019
Historique:
entrez:
29
1
2019
pubmed:
29
1
2019
medline:
1
7
2020
Statut:
ppublish
Résumé
Rapid organism identification and antimicrobial susceptibility testing (AST) can optimize antimicrobial therapy in patients with bacteraemia. The Accelerate Pheno™ system (ACC) can provide identification and AST results within 7 h of a positive culture. To assess the hypothetical impact of ACC on time to effective therapy (TTET), time to definitive therapy (TTDT) and antimicrobial usage at the Detroit Medical Center (DMC). Patients with positive blood cultures from 29 March to 24 June 2016 were included. ACC was performed in parallel with normal laboratory procedures, but results were not made available to the clinicians. The potential benefit of having ACC results was determined if clinicians modified therapy based on actual AST results. Potential changes in TTET, TTDT and antibiotic usage were calculated. One hundred and sixty-seven patients were included. The median TTET was 2.4 h (IQR 0.5, 15.1). Had ACC results been available, TTET could have been improved in four patients (2.4%), by a median decrease of 18.9 h (IQR 11.3, 20.4). The median TTDT was 41.4 h (IQR 21.7, 73.3) and ACC results could have improved TTDT among 51 patients (30.5%), by a median decrease of 25.4 h (IQR 18.7, 37.5). ACC implementation could have led to decreases in usage of cefepime (16% reduction), aminoglycosides (23%), piperacillin/tazobactam (8%) and vancomycin (4%). ACC results could potentially improve time to de-escalation and reduce use of antimicrobials. The impact of ACC on TTET was small, likely related to the availability of other rapid diagnostic tests at DMC.
Sections du résumé
Background
Rapid organism identification and antimicrobial susceptibility testing (AST) can optimize antimicrobial therapy in patients with bacteraemia. The Accelerate Pheno™ system (ACC) can provide identification and AST results within 7 h of a positive culture.
Objectives
To assess the hypothetical impact of ACC on time to effective therapy (TTET), time to definitive therapy (TTDT) and antimicrobial usage at the Detroit Medical Center (DMC).
Methods
Patients with positive blood cultures from 29 March to 24 June 2016 were included. ACC was performed in parallel with normal laboratory procedures, but results were not made available to the clinicians. The potential benefit of having ACC results was determined if clinicians modified therapy based on actual AST results. Potential changes in TTET, TTDT and antibiotic usage were calculated.
Results
One hundred and sixty-seven patients were included. The median TTET was 2.4 h (IQR 0.5, 15.1). Had ACC results been available, TTET could have been improved in four patients (2.4%), by a median decrease of 18.9 h (IQR 11.3, 20.4). The median TTDT was 41.4 h (IQR 21.7, 73.3) and ACC results could have improved TTDT among 51 patients (30.5%), by a median decrease of 25.4 h (IQR 18.7, 37.5). ACC implementation could have led to decreases in usage of cefepime (16% reduction), aminoglycosides (23%), piperacillin/tazobactam (8%) and vancomycin (4%).
Conclusions
ACC results could potentially improve time to de-escalation and reduce use of antimicrobials. The impact of ACC on TTET was small, likely related to the availability of other rapid diagnostic tests at DMC.
Identifiants
pubmed: 30690538
pii: 5300214
doi: 10.1093/jac/dky533
pmc: PMC6382028
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
i32-i39Références
Chest. 2000 Jul;118(1):146-55
pubmed: 10893372
Am J Med. 2003 Nov;115(7):529-35
pubmed: 14599631
Crit Care Med. 2006 Jun;34(6):1589-96
pubmed: 16625125
Shock. 2009 Feb;31(2):146-50
pubmed: 18636041
Chest. 2009 Nov;136(5):1237-1248
pubmed: 19696123
Crit Care Med. 2010 Apr;38(4):1045-53
pubmed: 20048677
Antimicrob Agents Chemother. 2012 Jan;56(1):472-8
pubmed: 22005999
BMC Med. 2014 Mar 06;12:40
pubmed: 24597462
Clin Infect Dis. 2014 Jul 15;59(2):272-8
pubmed: 24771332
MMWR Morb Mortal Wkly Rep. 2016 Apr 08;65(13):342-5
pubmed: 27054476
Chest. 2017 Feb;151(2):278-285
pubmed: 27452768
J Antimicrob Chemother. 2017 Jan;72(1):299-304
pubmed: 27986899
Intensive Care Med. 2017 Mar;43(3):304-377
pubmed: 28101605
Eur J Clin Microbiol Infect Dis. 2017 Oct;36(10):1879-1887
pubmed: 28534213
Crit Care. 2017 May 26;21(1):119
pubmed: 28545484
JAMA Intern Med. 2017 Sep 1;177(9):1308-1315
pubmed: 28604925
Crit Care Med. 2017 Sep;45(9):1443-1449
pubmed: 28817480
J Clin Microbiol. 2017 Dec 26;56(1):
pubmed: 29118168
Antimicrob Agents Chemother. 2018 Apr 26;62(5):
pubmed: 29483115