Abstract
ABSTRACTThe objective of this study was to evaluate whether the addition of the Verigene BC-GN molecular rapid diagnostic test to standard antimicrobial stewardship practices (mRDT + ASP) decreased the time to optimal and effective antimicrobial therapy for patients with extended-spectrum beta-lactamase (ESBL)- and carbapenemase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infections (BSI) compared to conventional microbiological methods with ASP (CONV + ASP). This was a multicenter, retrospective cohort study evaluating the time to optimal antimicrobial therapy in 5 years of patients with E. coli or K. pneumoniae BSI determined to be ESBL- or carbapenemase-producing by mRDT and/or CONV. Of the 378 patients included (mRDT + ASP, n = 164; CONV + ASP, n = 214), 339 received optimal antimicrobial therapy (mRDT + ASP, n = 161; CONV + ASP, n = 178), and 360 (mRDT + ASP, n = 163; CONV + ASP, n = 197) received effective antimicrobial therapy. The mRDT + ASP demonstrated a statistically significant decrease in the time to optimal antimicrobial therapy (20.5 h [interquartile range (IQR), 17.0 to 42.2 h] versus 50.1 h [IQR, 27.6 to 77.9 h]; P < 0.001) and the time to effective antimicrobial therapy (15.9 h [IQR, 1.9 to 25.7 h] versus 28.0 h [IQR, 9.5 to 56.7 h]; P < 0.001) compared to CONV + ASP, respectively.IMPORTANCE Our study supports the additional benefit of molecular rapid diagnostic test in combination with timely antimicrobial stewardship program (ASP) intervention on shortening the time to both optimal and effective antimicrobial therapy in patients with ESBL- or carbapenemase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infections, compared to conventional microbiological methods and ASP. Gram-negative infections are associated with significant morbidity and mortality, often resulting in life-threatening organ dysfunction. Both resistance phenotypes confer resistance to many of our first-line antimicrobial agents with carbapenemase-producing Enterobacterales requiring novel beta-lactam and beta-lactamase inhibitor combinations or other susceptible non-beta-lactam antibiotics for treatment. National resistance trends in a cohort of hospitalized patients at U.S. hospitals during our study period demonstrate the increasing incidence of both resistance phenotypes, reinforcing the generalizability and timeliness of such analysis.
Highlights
IMPORTANCE Our study supports the additional benefit of molecular rapid diagnostic test in combination with timely antimicrobial stewardship program (ASP) intervention on shortening the time to both optimal and effective antimicrobial therapy in patients with extendedspectrum beta-lactamases (ESBL)- or carbapenemase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infections, compared to conventional microbiological methods and Antimicrobial stewardship programs (ASP)
The purpose of this study was to evaluate whether the addition of Molecular rapid diagnostic tests (mRDT) to standard ASP practices decreased the time to optimal antimicrobial therapy for patients with either ESBL- or carbapenemaseproducing E. coli and K. pneumoniae bloodstream infections (BSI) compared to conventional microbiological methods with ASP (CONV 1 ASP)
Two quasi-experimental studies conducted by Bork et al and Sothoron et al demonstrated that coupling Verigene BC-GN mRDT to ASP decreased the time to optimal therapy by 18.3 and 10.8 h, respectively, compared to CONV 1 ASP for Gram-negative bloodstream infections (GN BSI) [12, 17]
Summary
IMPORTANCE Our study supports the additional benefit of molecular rapid diagnostic test in combination with timely antimicrobial stewardship program (ASP) intervention on shortening the time to both optimal and effective antimicrobial therapy in patients with ESBL- or carbapenemase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infections, compared to conventional microbiological methods and ASP. Gram-negative infections are associated with significant morbidity and mortality, often resulting in life-threatening organ dysfunction Both resistance phenotypes confer resistance to many of our first-line antimicrobial agents with carbapenemase-producing Enterobacterales requiring novel beta-lactam and beta-lactamase inhibitor combinations or other susceptible non-beta-lactam antibiotics for treatment. Gram-negative bloodstream infections (GN BSI) are associated with significant morbidity and mortality, often resulting in life-threatening organ dysfunction, such as sepsis and septic shock [1] This scenario has worsened, with Gram-negative Enterobacterales driving the emergence of drug-resistant pathogens, which are difficult to treat or even untreatable with conventional antimicrobials [2]. The purpose of this study was to evaluate whether the addition of mRDT to standard ASP practices (mRDT 1 ASP) decreased the time to optimal antimicrobial therapy for patients with either ESBL- or carbapenemaseproducing E. coli and K. pneumoniae BSI compared to conventional microbiological methods with ASP (CONV 1 ASP)
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