Abstract
BackgroundRapid identification of positive blood cultures is important for initiation of optimal treatment in septic patients. Effects of automated, microarray-based rapid identification systems on antibiotic prescription against community-onset bacteremia (COB) remain unclear.MethodsWe prospectively enrolled 177 patients with 185 COB episodes (occurring within 72 h of admission) over 17 months. Bacteremia episodes due to gram-positive bacteria (GP) and gram-negative bacteria (GN) in the same patient were counted separately. For GP bacteremia, patients with ≥2 sets of positive blood cultures were included. The primary study objective was evaluating the rates of antibiotic prescription changes within 2 days of rapid identification using the Verigene system.ResultsBacteremia due to GN and GP included 144/185 (77.8%) and 41/185 (22.2%) episodes, respectively. Antibiotic prescription changes occurred in 51/185 cases (27.6% [95%CI:21.3–34.6%]) after Verigene analysis and 70/185 cases (37.8% [30.8–45.2%]) after conventional identification and susceptibility testing. Prescription changes after Verigene identification were more frequent in GP (17/41[41.5%]) than in GN (34/144[23.5%]). Among bacteremia due to single pathogen targeted by Verigene test, bacterial identification agreement between the two tests was high (GP: 38/39[97.4%], GN: 116/116[100%]). The Verigene test correctly predicted targeted antimicrobial resistance. The durations between the initiation of incubation and reporting of the results for the Verigene system and conventional test was 28.3 h (IQR: 25.8–43.4 h) and 90.6 h (68.3–118.4 h), respectively. In only four of the seven episodes of COB in which two isolates were identified by conventional tests, the Verigene test correctly identified both organisms.ConclusionWe observed a high rate of antibiotic prescription changes after the Verigene test in a population with COB especially in GP. The Verigene test would be a useful tool in antimicrobial stewardship programs among patients with COB.
Highlights
Rapid identification of positive blood cultures is important for the rapid initiation of optimal treatment in patients with bacteremia, increasing the opportunity for antimicrobial stewardship programs (ASPs) [1]
Among bacteremia due to single pathogen targeted by Verigene test, bacterial identification agreement between the two tests was high (GP: 38/39[97.4%], gram-negative bacteria (GN): 116/116[100%])
We observed a high rate of antibiotic prescription changes after the Verigene test in a population with community-onset bacteremia (COB) especially in gram-positive bacteria (GP)
Summary
Rapid identification of positive blood cultures is important for the rapid initiation of optimal treatment in patients with bacteremia, increasing the opportunity for antimicrobial stewardship programs (ASPs) [1]. Among the variety of available rapid identification systems, the Verigene gram-positive and gram-negative blood culture nucleic acid test (BC-GP, BC-GN; Nanosphere Inc., Northbrook, IL, USA), an automated microarray-based rapid identification system, is able to identify multiple bacterial species and their resistance genes, and the microbiological and clinical utility and impact of automated systems have been reported [2,3,4,5]. Considering its ability to identify common resistance genes and some typical healthcare-associated bacteria (e.g., methicillin-resistant Staphylococcus aureus [MRSA], Pseudomonas aeruginosa, Acinetobacter spp., and Serratia marcescens), the use of the Verigene system is expected to have clinical impact, including effects on antimicrobial prescriptions against hospital-acquired bacteremia. Microarray-based rapid identification systems on antibiotic prescription against community-onset bacteremia (COB) remain unclear
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