Abstract
We performed a systematic review of the data regarding rapid diagnostic tests and their advantages or limitations on patients’ clinical outcomes. The PubMed and Scopus databases were searched independently by two reviewers. Mortality was the primary outcome. Most studies compared rapid tests with blood cultures. Although not observed in all studies, only studies comparing rapid tests in conjunction with antimicrobial stewardship programs (ASPs) showed a mortality benefit. A reduction in hospital or intensive care unit (ICU) length of stay was also observed in almost all studies when the rapid tests, with or without ASPs, were used. Finally, treatment decisions were taken earlier in the rapid test groups. Despite a faster treatment decision, a clear mortality benefit was not seen when rapid tests were used. It is crucial to differentiate the influence of rapid tests from that of ASPs and clarify the actual effect of each factor separately.
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Kaye KS, Marchaim D, Chen TY et al (2014) Effect of nosocomial bloodstream infections on mortality, length of stay, and hospital costs in older adults. J Am Geriatr Soc 62:306–311
Al-Rawajfah OM, Stetzer F, Hewitt JB (2009) Incidence of and risk factors for nosocomial bloodstream infections in adults in the United States, 2003. Infect Control Hosp Epidemiol 30:1036–1044
Kollef MH (2000) Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis 31(Suppl 4):S131–S138
Weinstein MP, Murphy JR, Reller LB, Lichtenstein KA (1983) The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. Ii. Clinical observations, with special reference to factors influencing prognosis. Rev Infect Dis 5:54–70
Pittet D, Tarara D, Wenzel RP (1994) Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 271:1598–1601
Martin MA (1991) Epidemiology and clinical impact of gram-negative sepsis. Infect Dis Clin North Am 5:739–752
Blot S, Cankurtaran M, Petrovic M et al (2009) Epidemiology and outcome of nosocomial bloodstream infection in elderly critically ill patients: a comparison between middle-aged, old, and very old patients. Crit Care Med 37:1634–1641
Klouche M, Schröder U (2008) Rapid methods for diagnosis of bloodstream infections. Clin Chem Lab Med 46:888–908
Peters RP, van Agtmael MA, Danner SA, Savelkoul PH, Vandenbroucke-Grauls CM (2004) New developments in the diagnosis of bloodstream infections. Lancet Infect Dis 4:751–760
Paolucci M, Landini MP, Sambri V (2010) Conventional and molecular techniques for the early diagnosis of bacteraemia. Int J Antimicrob Agents 36(Suppl 2):S6–S16
Lamas CC, Eykyn SJ (2003) Blood culture negative endocarditis: analysis of 63 cases presenting over 25 years. Heart 89:258–262
Huttunen R, Syrjänen J, Vuento R, Aittoniemi J (2013) Current concepts in the diagnosis of blood stream infections. Are novel molecular methods useful in clinical practice? Int J Infect Dis 17:e934–e938
Chang SS, Hsieh WH, Liu TS et al (2013) Multiplex PCR system for rapid detection of pathogens in patients with presumed sepsis—a systemic review and meta-analysis. PLoS One 8:e62323
Dark P, Wilson C, Blackwood B et al (2012) Accuracy of LightCycler(R) SeptiFast for the detection and identification of pathogens in the blood of patients with suspected sepsis: a systematic review protocol. BMJ Open 2:e000392
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 51:1074–1080
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 49:1581–1582
Carver PL, Lin SW, DePestel DD, Newton DW (2008) Impact of mecA gene testing and intervention by infectious disease clinical pharmacists on time to optimal antimicrobial therapy for Staphylococcus aureus bacteremia at a university hospital. J Clin Microbiol 46:2381–2383
Parta M, Goebel M, Thomas J, Matloobi M, Stager C, Musher DM (2010) Impact of an assay that enables rapid determination of Staphylococcus species and their drug susceptibility on the treatment of patients with positive blood culture results. Infect Control Hosp Epidemiol 31:1043–1048
Cattoir V, Merabet L, Djibo N et al (2011) Clinical impact of a real-time PCR assay for rapid identification of Staphylococcus aureus and determination of methicillin resistance from positive blood cultures. Clin Microbiol Infect 17:425–431
Wong JR, Bauer KA, Mangino JE, Goff DA (2012) Antimicrobial stewardship pharmacist interventions for coagulase-negative staphylococci positive blood cultures using rapid polymerase chain reaction. Ann Pharmacother 46:1484–1490
Forrest GN, Mehta S, Weekes E, Lincalis DP, Johnson JK, Venezia RA (2006) Impact of rapid in situ hybridization testing on coagulase-negative staphylococci positive blood cultures. J Antimicrob Chemother 58:154–158
Nicolsen NC, LeCroy N, Alby K et al (2013) Clinical outcomes with rapid detection of methicillin-resistant and methicillin-susceptible Staphylococcus aureus isolates from routine blood cultures. J Clin Microbiol 51:4126–4129
Nguyen DT, Yeh E, Perry S et al (2010) Real-time PCR testing for mecA reduces vancomycin usage and length of hospitalization for patients infected with methicillin-sensitive staphylococci. J Clin Microbiol 48:785–790
Kirkbright S, Fatovich D, Kee C et al (2011) Quantitative rt-PCR holds promise as a screening tool for patients with severe sepsis. Emerg Med Australas 23:502–506
Chuang YC, Chang SC, Wang WK (2010) High and increasing Oxa-51 DNA load predict mortality in Acinetobacter baumannii bacteremia: implication for pathogenesis and evaluation of therapy. PLoS One 5:e14133
Carrol ED, Guiver M, Nkhoma S et al (2007) High pneumococcal DNA loads are associated with mortality in Malawian children with invasive pneumococcal disease. Pediatr Infect Dis J 26:416–422
Ho YC, Chang SC, Lin SR, Wang WK (2009) High levels of mecA DNA detected by a quantitative real-time PCR assay are associated with mortality in patients with methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol 47:1443–1451
Tran NK, Wisner DH, Albertson TE et al (2012) Multiplex polymerase chain reaction pathogen detection in patients with suspected septicemia after trauma, emergency, and burn surgery. Surgery 151:456–463
Bloos F, Hinder F, Becker K et al (2010) A multicenter trial to compare blood culture with polymerase chain reaction in severe human sepsis. Intensive Care Med 36:241–247
Lehmann LE, Alvarez J, Hunfeld KP et al (2009) Potential clinical utility of polymerase chain reaction in microbiological testing for sepsis. Crit Care Med 37:3085–3090
Sango A, McCarter YS, Johnson D, Ferreira J, Guzman N, Jankowski CA (2013) Stewardship approach for optimizing antimicrobial therapy through use of a rapid microarray assay on blood cultures positive for Enterococcus species. J Clin Microbiol 51:4008–4011
Perez KK, Olsen RJ, Musick WL et al (2014) Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia. J Infect 69:216–225
Perez KK, Olsen RJ, Musick WL et al (2013) Integrating rapid pathogen identification and antimicrobial stewardship significantly decreases hospital costs. Arch Pathol Lab Med 137:1247–1254
Nagel JL, Huang AM, Kunapuli A et al (2014) Impact of antimicrobial stewardship intervention on coagulase-negative Staphylococcus blood cultures in conjunction with rapid diagnostic testing. J Clin Microbiol 52:2849–2854
Huang AM, Newton D, Kunapuli A et al (2013) Impact of rapid organism identification via matrix-assisted laser desorption/ionization time-of-flight combined with antimicrobial stewardship team intervention in adult patients with bacteremia and candidemia. Clin Infect Dis 57:1237–1245
Ly T, Gulia J, Pyrgos V, Waga M, Shoham S (2008) Impact upon clinical outcomes of translation of PNA FISH-generated laboratory data from the clinical microbiology bench to bedside in real time. Ther Clin Risk Manag 4:637–640
Forrest GN, Roghmann MC, Toombs LS et al (2008) Peptide nucleic acid fluorescent in situ hybridization for hospital-acquired enterococcal bacteremia: delivering earlier effective antimicrobial therapy. Antimicrob Agents Chemother 52:3558–3563
Alvarez J, Mar J, Varela-Ledo E et al (2012) Cost analysis of real-time polymerase chain reaction microbiological diagnosis in patients with septic shock. Anaesth Intensive Care 40:958–963
Frye AM, Baker CA, Rustvold DL et al (2012) Clinical impact of a real-time PCR assay for rapid identification of staphylococcal bacteremia. J Clin Microbiol 50:127–133
Pogue JM, Mynatt RP, Marchaim D et al (2014) Automated alerts coupled with antimicrobial stewardship intervention lead to decreases in length of stay in patients with gram-negative bacteremia. Infect Control Hosp Epidemiol 35:132–138
Falagas ME, Tassios PT (2008) Enhanced and earlier detection of bacteremia and fungemia by multiplex polymerase chain reaction: How much enhanced, how much earlier, and at what cost? Crit Care Med 36:1660–1661
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Vardakas, K.Z., Anifantaki, F.I., Trigkidis, K.K. et al. Rapid molecular diagnostic tests in patients with bacteremia: evaluation of their impact on decision making and clinical outcomes. Eur J Clin Microbiol Infect Dis 34, 2149–2160 (2015). https://doi.org/10.1007/s10096-015-2466-y
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DOI: https://doi.org/10.1007/s10096-015-2466-y