Impact of antimicrobial stewardship and rapid microarray testing on patients with Gram-negative bacteremia
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A rapid microarray assay, Nanosphere Verigene® Gram-negative blood culture test (BC-GN), detects four Gram-negative species, four Gram-negative genera, and six resistance genes directly from positive blood culture samples, shortening the time from Gram stain to pathogen and resistance-gene identification. The purpose of this study was to determine the impact of the BC-GN paired with an antimicrobial stewardship intervention on antimicrobial and clinical outcomes. Patients with Gram-negative bacteremia were compared before (n = 456) and after (n = 421) BC-GN implementation. The primary objective was to compare time from Gram stain to antimicrobial switch pre- and post-implementation. Time from Gram stain to effective treatment, in-hospital mortality, and hospital length of stay were also compared. The number and type of antimicrobial switches were similar between groups. Median (IQR) time from Gram stain to antimicrobial switch was significantly decreased in the post group, 28.6 (8.6–56.9) h vs 44.1 (18.9–64.6) h, p = 0.004. In patients on ineffective antimicrobial therapy at the time of result, median time to effective therapy was lower in the post group, 8.8 (5.5–18.4) h vs 24.5 (4.9–44.3) h, p = 0.034. Median (IQR) hospital length of stay was also decreased in the post group, 7 (5–15) days vs 9 (4.5–21) days, p = 0.001. The rate of in-hospital mortality was similar between groups, 11.6% (pre) vs 11.4% (post), p = 0.87. Rapid microarray testing on blood cultures combined with active antimicrobial stewardship intervention was associated with decreased time to antimicrobial switch, time to effective therapy, and hospital length of stay.
KeywordsBlood cultures Antimicrobial stewardship Gram-negative bacteremia Rapid diagnostic tests
Compliance with ethical standards
No funding was received to conduct this study.
Conflicts of interest
S.S.R. receives research funding from Nanosphere and BioMerieux.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
The study protocol was approved by the Cleveland Clinic Health System institutional review board, which waived the requirement for informed consent due to the retrospective nature of the evaluation.
- 1.Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Samore MH, Seo SK, Trivedi KK (2016) Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 62:e51–e77CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Bauer KA, West JE, Balada-Llasat JM, Pancholi P, Stevenson KB, Goff DA (2010) An antimicrobial stewardship program’s impact with rapid polymerase chain reaction methicillin-resistant Staphylococcus Aureus/S. Aureus blood culture test in patients with S. Aureus bacteremia. Clin Infect Dis 51:1074–1080CrossRefPubMedGoogle Scholar
- 3.Beal SG, Thomas C, Dhiman N, Nguyen D, Qin H, Hawkins JM, Dekmezian M, Benavides R (2015) Antibiotic utilization improvement with the Nanosphere Verigene Gram-positive blood culture assay. Proc (Bayl Univ Med Cent) 28:139–143Google Scholar
- 4.Box MJ, Sullivan EL, Ortwine KN, Parmenter MA, Quigley MM, Aguilar-Higgins LM, MacIntosh CL, Goerke KF, Lim RA (2015) Outcomes of rapid identification for Gram-positive bacteremia in combination with antibiotic stewardship at a community-based hospital system. Pharmacotherapy 35:269–276CrossRefPubMedGoogle Scholar
- 5.Walker T, Dumadag S, Lee CJ, Lee SH, Bender JM, Cupo Abbott J, She RC (2016) Clinical impact of laboratory implementation of Verigene BC-GN microarray-based assay for detection of Gram-negative bacteria in positive blood cultures. J Clin Microbiol 54:1789–1796CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Sothoron C, Ferreira J, Guzman N, Aldridge P, McCarter YS, Jankowski CA (2015) A stewardship approach to optimize antimicrobial therapy through use of a rapid microarray assay on blood cultures positive for Gram-negative bacteria. J Clin Microbiol 53:3627–3629CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, Oh MD, Choe KW (2005) Bloodstream infections caused by antibiotic-resistant Gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother 49:760–766CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Centers for Disease Control and Prevention (2013) Antibiotic resistance threats in the United States. US Department of Health and Human ServicesGoogle Scholar
- 9.Verigene® Gram-Negative Blood Culture Nucleic Acid Test (BC-GN) (2015) [Package Insert] Nanosphere, Luminex Corp, NorthbrookGoogle Scholar
- 10.Bork JT, Leekha S, Heil EL, Zhao L, Badamas R, Johnson JK (2015) Rapid testing using the Verigene Gram-negative blood culture nucleic acid test in combination with antimicrobial stewardship intervention against Gram-negative bacteremia. Antimicrob Agents Chemother 59:1588–1595CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Hill JT, Tran KD, Barton KL, Labreche MJ, Sharp SE (2014) Evaluation of the nanosphere Verigene BC-GN assay for direct identification of gram-negative bacilli and antibiotic resistance markers from positive blood cultures and potential impact for more-rapid antibiotic interventions. J Clin Microbiol 52:3805–3807CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Clinical and Laboratory Standards Institute (2016) Performance standards for antimicrobial susceptibility testing: twenty-fourth informational supplement. In: Document M100-S26. CLSI, WayneGoogle Scholar
- 14.Madaras-Kelly K, Jones M, Remington R, Hill N, Huttner B, Samore M (2014) Development of an antibiotic spectrum score based on veterans affairs culture and susceptibility data for the purpose of measuring antibiotic de-escalation: a modified Delphi approach. Infect Control Hosp Epidemiol 35:1103–1113CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Holtzman C, Whitney D, Barlam T, Miller NS (2011) Assessment of impact of peptide nucleic acid fluorescence in situ hybridization for rapid identification of coagulase-negative staphylococci in the absence of antimicrobial stewardship intervention. J Clin Microbiol 49:1581–1582CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Banerjee R, Teng CB, Cunningham SA, Ihde SM, Steckelberg JM, Moriarty JP, Shah ND, Mandrekar JN, Patel R (2015) Randomized trial of rapid multiplex polymerase chain reaction-based blood culture identification and susceptibility testing. Clin Infect Dis 61:1071–1080CrossRefPubMedPubMedCentralGoogle Scholar
- 21.The Johns Hopkins Hospital Antimicrobial Stewardship Program (2013) Interpretation of rapid diagnostic tests. In: Antibiotic Dosing Guidelines 2013–2014. Johns Hopkins Medicine, BaltimoreGoogle Scholar