Clinical and Financial Impact of Rapid Antimicrobial Susceptibility Testing in Blood Cultures.

Felix Roth,Nathan D Leedahl,Dubert M Guerrero,David D Leedahl

doi:10.3390/antibiotics11020122

Abstract

The rapid identification of pathogens that cause bloodstream infections plays a vital role in the modern clinical microbiology laboratory. Despite demonstrating a significant reduction in turnaround time and a significant effect on clinical decisions, most methods do not provide complete antimicrobial susceptibility testing (AST) information. We employed rapid identification (ID) and AST using the Accelerate PhenoTest on positive blood cultures containing Gram-negative bacilli. The length of stay (LOS) significantly decreased from an average of 12.1 days prior to implementation to 6.6 days post-implementation (p = 0.02), representing potential total savings of USD 666,208.00. All-cause mortality did not differ significantly, 27 (19%) versus 18 (12%), p = 0.11. We also observed an associated decrease in the use of broad-spectrum antimicrobials, including meropenem and quinolones. The implementation of a rapid ID and AST method, along with a well-established antimicrobial stewardship program, has the potential to decrease LOS, broad-spectrum antibiotic use, and costs to the healthcare system, with no observable impact on mortality.

Highlights

Rapid Antimicrobial SusceptibilityBloodstream infections (BSI) remain a significant cause of morbidity and death, most notable among the elderly and other high-risk populations, with an approximate mortality of up to 80% [1,2,3]
This study reports the economic and clinical impact of adopting Accelerate PhenoTM (ACC) in a teaching community hospital
A number of the blood cultures were polymicrobial, and the most common organism isolated was E. coli for both the pre-ACC and post-ACC patients, in 120 (52%) and 160 (59%) patients, respectively. This was followed by Klebsiella pneumoniae and Pseudomonas aeruginosa

Summary

Introduction

Rapid Antimicrobial SusceptibilityBloodstream infections (BSI) remain a significant cause of morbidity and death, most notable among the elderly and other high-risk populations, with an approximate mortality of up to 80% [1,2,3]. The utilization of rapid molecular methods in the form of microarrays to identify the potential cause of BSI has irrefutably improved the management of BSI [5,6,7] Most of these platforms are unable to provide information on susceptibilities and still rely on semi-automated methods that require at least 18 h of incubation, which may lead to potential delays in accessing appropriate antimicrobials. A new FDA-approved platform, Accelerate PhenoTM (ACC) (Accelerate Diagnostics, Tucson, AZ), offers a solution for rapid AST in positive blood culture specimens [9,10] To our knowledge, this is the only United States Food and Drug Administration (FDA)-cleared platform using a morphokinetic approach to obtain AST results; its implementation posed a reliable solution to expedite AST results and improve patient care. This study reports the economic and clinical impact of adopting ACC in a teaching community hospital

Methods

Results

Conclusion