Abstract
BackgroundT2Dx was approved by the US Food and Drug Administration for the rapid detection of a modified panel of ESKAPE bacterial species or Candida spp. causing bloodstream infection (BSI).Patients and methodsWe performed a retrospective, observational study from January 1, 2018 to December 31, 2019 of all hospitalised patients with suspected BSI who underwent assessment using T2Dx in addition to standard blood culture (BC). T2-positive patients (cases) were compared to a matched group of patients with BSI documented only by BC (1:2 ratio) to investigate the possible impact of T2Dx on the appropriateness of empirical antimicrobial therapy and 21-day mortality.ResultsIn total, 78 T2Dx-analysed samples (49 patients) were analysed. The T2Dx assay result was positive for18 patients and negative for 31 patients. The concordance rates of the T2Bacteria Panel and T2Candida Panel results with those of standard BC were 74.4% and 91.4%, respectively. In the matched analysis, inappropriate empiric antimicrobial therapy administration was significantly less frequent in cases than in comparators (5.5% vs. 38.8%). The 21-day mortality rate was twofold lower in cases than in comparators (22.2% vs. 44.4%), although the difference was not significant. No other analysed variables were significantly different between the two groups.ConclusionsThis study illustrated that T2Dx might be associated with an increase in the appropriateness of empiric antimicrobial therapy in patients with BSI. Further studies are needed to evaluate whether the T2Dx assay can improve patient outcomes.
Highlights
T2Dx was approved by the US Food and Drug Administration for the rapid detection of a modified panel of ESKAPE bacterial species or Candida spp. causing bloodstream infection (BSI)
Antimicrobial-resistant ESKAPE (i.e., Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species) microorganisms represent a frequent cause of nosocomial BSI [5, 6], and they can acquire antimicrobial resistance genes, thereby reducing treatment options and increasing death rates because of treatment failure [7]
Blood culture (BC) is considered the gold standard for BSI diagnosis and it serves as an indispensable assessment method [12], it is often limited by slow turnaround times or the failure to identify causative pathogens [1, 13]
Summary
T2Dx was approved by the US Food and Drug Administration for the rapid detection of a modified panel of ESKAPE bacterial species or Candida spp. causing bloodstream infection (BSI). Delayed administration of active anti-infective therapy is associated with increased rates of mortality and higher medical costs in patients with severe infections, especially bloodstream infection (BSI) [1, 2]. Antimicrobial-resistant ESKAPE (i.e., Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species) microorganisms represent a frequent cause of nosocomial BSI [5, 6], and they can acquire antimicrobial resistance genes, thereby reducing treatment options and increasing death rates because of treatment failure [7]. Because timely and appropriate antimicrobial treatment has a key role in reducing the risk of poor outcomes [4, 9, 15, 16], the development of minimally invasive, highly sensitive and specific diagnostic tests with a short turnaround time and reasonable cost could significantly improve outcomes in patients with bacterial or fungal BSI [1]
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