Abstract
The role of empirical therapy and time to first effective treatment, including the antimicrobial stewardship program, are decisive in patients presenting with bloodstream infections (BSI). The FilmArray® Blood Culture Identification Panel (FA BCID 1.0) detects 24 bacterial and fungal pathogens as well as 3 resistance genes from positive blood cultures in approximately 70 min. In this paper, we evaluate the impact of the additional FA BCID analysis on the time to an optimal antimicrobial therapy and on the length of stay in the ICU, ICU mortality, and PCT level reduction. This retro-/prospective trial was conducted in BSI patients in the ICU at a German tertiary care hospital. A total of 179 individual patients with 200 episodes of BSI were included in the prospective intervention group, and 150 patients with 170 episodes of BSI in the retrospective control group. In the intervention group, BSI data were analyzed including the MALDI-TOF MS (matrix assisted laser desorption ionization time-of-flight mass spectrometry) and FA BCID results from January 2019 to August 2020; the data from the control group, including the MALDI-TOF results, were collected retrospectively from the year 2018. The effective and appropriate antimicrobial regimen occurred in a median of 17 hours earlier in the intervention versus control group (p = 0.071). Furthermore, changes in the antimicrobial regimens of the intervention group that did not immediately lead to an optimal therapy occurred significantly earlier by a median of 24 hours (p = 0.029). Surrogate markers, indicating an earlier recovery of the patients from the intervention group, such as length of stay at the ICU, duration of mechanical ventilation, or an earlier reduction in PCT level, were not significantly affected. However, mortality did not differ between the patient groups. A postulated reduction of the antimicrobial therapy, in those cases in which coagulase-negative Staphylococcus species were identified, did occur in the control group, but not in the intervention group (p = 0.041). The implementation of FA BCID into the laboratory workflow can improve patient care by optimizing antimicrobial regimen earlier in BSI patients as it provides rapid and accurate results for key pathogens associated with BSI, as well as important antimicrobial resistance markers, e.g., mecA or vanA.
Highlights
Sepsis and bloodstream infections (BSI) still pose diagnostic and therapeutic challenges
The markers to objectify the impact of the FilmArray® Blood Culture Identification Panel (FA BCID) compared to the retrospective group were the length of stay in the intensive care unit (ICU), the time spent on invasive ventilation, and ICU mortality
We were able to show an earlier optimization of antimicrobial therapy in patients that were treated for BSI with the use of the FA BCID (Tables 1 and 2)
Summary
Sepsis and bloodstream infections (BSI) still pose diagnostic and therapeutic challenges. BSI are among the leading causes of morbidity and mortality worldwide. An estimated 19 million hospitalizations in intensive care units occur worldwide each year, resulting in a death rate of 25% in these patients [1,2,3]. A timely administration of antimicrobial therapy reduces mortality and morbidity, as long as it is effective against the causative microorganism of the BSI or sepsis [3,4,5,6]. With the wide availability of broadspectrum antimicrobials, administering an effective and appropriate antimicrobial regimen at the initial phase has been related to a better outcome, especially for patients with severe sepsis or septic shock. The empiric administration of broad-spectrum antibiotics leads to unnecessary antibiotic exposure and to a high risk of selecting drug-resistant microorganisms
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