Blood Culture Identification Panel Research Articles

Clinical impact and cost-consequence analysis of ePlex® blood culture identification panels for the rapid diagnosis of bloodstream infections: a single-center randomized controlled trial.

To assess clinical impact and perform cost-consequence analysis of the broadest multiplex PCR panels available for the rapid diagnosis of bloodstream infections (BSI). Single-center, randomized controlled trial conducted from June 2019 to February 2021 at a French University hospital with an institutional antimicrobial stewardship program. Primary endpoint was the percentage of patients with optimized antimicrobial treatment 12h after transmission of positivity and Gram stain results from the first positive BC. This percentage was significantly higher in the multiplex PCR (mPCR) group (90/105 = 85.7% %, CI95% [77.5 ; 91.8] vs. 68/107 = 63.6%, CI95% [53.7 ; 72.6]; p < 10- 3) at interim analysis, resulting in the early termination of the study after the inclusion of 309 patients. For patients not optimized at baseline, the median time to obtain an optimized therapy was much shorter in the mPCR group than in the control group (6.9h, IQR [2.9; 17.8] vs. 26.4h, IQR [3.4; 47.5]; p = 0.001). Early optimization of antibiotic therapy resulted in a non-statistically significant decrease in mortality from 12.4 to 8.8% (p = 0.306), with a trend towards a shorter median length of stay (18 vs. 20 days; p = 0.064) and a non-significant reduction in the average cost per patient of €3,065 (p = 0.15). mPCR identified all the bacteria present in 88% of the samples. Despite its higher laboratory cost, the use of multiplex PCR for BSI diagnosis leads to early-optimised therapy, seems cost-effective and could reduce mortality and length of stay. Their impact could probably be improved if implemented 24/7.

BioFire FilmArray Blood Culture Identification (BCID) Panel and Clinical Usefulness: A Systematic Review

BioFire FilmArray Blood Culture Identification (BCID) Panel and Clinical Usefulness: A Systematic Review

Performance of ePlex® blood culture identification panels in clinical isolates and characterization of antimicrobial stewardship opportunities

We assessed the performance of GenMark's ePlex® Blood Culture Identification (BCID) Panels for overall agreement of organism identification and resistance mechanism detection with standard microbiologic methods. This study included patients with a positive blood culture from May 2020 to January 2021. The primary outcomes were to assess concordance of ePlex® organism identification with standard identification methods and concordance of ePlex® genotypic resistance mechanism detection with standard phenotypic susceptibility testing. Secondary outcomes included panel specific performance and characterization of antimicrobial stewardship opportunities. The overall identification concordance rate in 1276 positive blood cultures was 98.1%. The overall concordance for the presence of resistance markers was 98.2% and concordance for the absence of resistance markers was 100%. A majority of ePlex® results (69.5%) represented opportunities for potential antimicrobial stewardship intervention. High concordance rates between the ePlex® BCID panels and standard identification and susceptibility methods enable utilization of results to guide rapid antimicrobial optimization.

Clinical utility of multiplex PCR in the detection of pathogens from sterile body fluids.

The identification of pathogens in normally sterile body fluid (NSBF) is performed using routine culture, the current gold standard. Limitations of this method include sensitivity and increased turnaround times which could potentially delay vital patient care, especially antimicrobial therapy. Adaptations of NSBF in blood culture bottles prompted us to consider the utility of additional methods to bridge the gap in diagnostic challenges for these life-threatening infections. Multiplex molecular panels have been manufactured for use with multiple specimen types including blood, cerebral spinal fluid, stool, and respiratory. Therefore, the purpose of this study was to evaluate the off-label use of ePlex Blood Culture Identification Panels on positive body fluids grown in blood culture bottles for the detection of microorganisms for research purposes.

The impact of implementation of rapid blood culture identification panels on antimicrobial optimization: a retrospective cohort study.

Determine the impact of limited implementation of a rapid blood culture identification (BCID) panel. Retrospective cohort study. From February to April 2022, positive blood cultures identified via e-Plex BCID (Roche, Carlsbad, CA) were compared to those identified using standard microbial identification techniques. The primary outcomes assessed were time to optimal therapy, time to de-escalation of anti-MRSA (methicillin-resistant Staphylococcus aureus) agents, and time to de-escalation of anti-pseudomonal agents. Additional analysis investigated the impact of the availability of antimicrobial stewardship program support. This study was conducted at Grady Health System, a large metropolitan safety-net hospital in the southeastern United States. A total of 253 blood cultures were included in this study (153 BCID and 100 standard). Blood culture identification use was associated with a reduction in median time to optimal antimicrobial therapy (43.4 vs 72.1 h, P < .001) and median time to de-escalation of anti-MRSA agents (27.7 vs 46.7 h, P = .006), and a trend towards reduction of median time to de-escalation of anti-pseudomonal agents (38.8 vs 54.8 h, P = .07). These reductions persisted when controlling for patient age, sex, intensive care unit status, Charlson Comorbidity Index, and antimicrobial stewardship program availability. Despite restricted use and lack of 24/7 antimicrobial stewardship program availability, BCID panel utilization was associated with earlier initiation of optimal therapy and pathogen identification with subsequent de-escalation of broad-spectrum antimicrobials, as compared to standard antimicrobial techniques. This suggests the potential for benefit from adopting novel diagnostic technologies outside of idealized fully-resourced settings.

Pitfalls of a Multiplex PCR Panel for Identification of Bloodstream Pathogens.

We evaluated the diagnostic performance of the FilmArray Blood Culture Identification Panel (BCID; bioMerieux) for the detection of bloodstream pathogens. From May to August 2022, up to 67 samples from positive blood cultures previously processed with BACTEC FX (BD) were collected and submitted to the BCID panel. BCID panel results were compared with traditional culture results. We tested 67 positive blood culture samples; 13 samples were from pediatric bottles of BACTEC Peds Plus/F media (BD). The overall sensitivity of the BCID panel was 89.9% (62/69; 95% CI, 80.2 - 95.3%). For blood-stream pathogens targeted by the BCID panel, sensitivity was 98.4% (62/63; 95% CI, 90.7 - > 99.9%). Interestingly, Proteus species were additionally detected in 6 samples from pediatric blood culture bottles. BCID demonstrated high clinical sensitivity for target pathogens, but positive findings for unexpected multiple targets or Proteus species require cautious interpretation to avoid false positives.

1695. Epidemiology of Positive Blood Cultures with Negative BioFire® Blood Culture Identification Panel Results at a Pediatric Center

Abstract Background The BioFire® Blood Culture Identification (BCID) Panel is a rapid multiplex PCR assay designed to identify common bloodstream infection (BSI) organisms from positive blood cultures (Figure 1). Although a positive BCID result can identify and often guide pathogen-directed treatment, a negative result may lead to uncertainty. Therefore, we aimed to describe the organisms isolated from cultures with negative BCID tests in pediatric patients. Figure 1 Targets on the BioFire Blood Culture Identification Panels 1 vs. 2 Methods In this retrospective study of children (≤ 21 years) in our health system, we extracted all BCID tests performed 01/01/2018 to 03/12/2023 from the electronic medical record (EMR). We excluded positive BCID tests and from the negative tests, excluded duplicates, those with no growth and isolated Gram-positive rod Gram stain. Demographic, clinical, and culture data were abstracted from the EMR. Host status was categorized as previously healthy (PH), chronic condition (CC), and immunocompromised (IC). Descriptive statistics were used to summarize the data. Results Of the 4049 BCID tests (3123 BCID1, 926 BCID2) performed, 387 resulted negative (327 BCID1 [10.4%], 61 BCID2 [6.6%]). After applying exclusion criteria, 351 negative BCID tests (296 BCID1, 55 BCID2) from 325 patients were included in the dataset. Among the 351 negative tests, 81 (23.1%) were in PH hosts, 151 (43.0%) in CC hosts, and 119 (33.9%) in IC hosts. The majority (n=208, 59.3%) of negative test results were from cultures drawn peripherally. Eighteen tests (5.1%) resulted in polymicrobial growth, and 156 (44.4%) were not treated as BSIs by the clinician (Table 1). After the BCID negative result, the median delay in organism identification using conventional methods was 28.9 hours. The 351 cultures from negative BCID tests yielded 372 organisms with the most common Micrococcus spp. (Figure 2). Table 1 Demographic and culture characteristics of patients with negative BioFire BCID test results: a comparison between BCID1 and BCID2 Figure 2 Top 3 organisms isolated from positive cultures with negative BioFire BCID tests, stratified by patient host status and reported Gram stain Conclusion In this large pediatric cohort, the BioFire® BCID1 was negative in 10.4% of tests, decreasing to 6.6% with BCID2. We provide clinicians with a useful resource of organisms isolated from cultures with negative BCID results based on underlying host status. With an identification delay of &amp;gt; 24 hours for the majority of BCID negative tests and many not ultimately treated as BSIs, the impact of negative BCID results on antimicrobial stewardship efforts remains an area of future study. Disclosures Pratik A. Patel, MD, Cardinal Health Inc: Advisor/Consultant

164. Performance of ePlex® Blood Culture Identification Panels in Clinical Isolates and Characterization of Antimicrobial Stewardship Opportunities

Abstract Background Rapid diagnostic testing allows pathogen identification within hours of a positive blood culture. GenMark’s ePlex® Blood Culture Identification (BCID) Panels detect bacteria, fungi, and antibiotic resistance genes. This study assessed concordance of ePlex® organism identification with standard microbiologic identification methods and concordance of ePlex® genotypic resistance mechanism detection and standard susceptibility testing. Secondary outcomes included panel specific performance and characterization of antimicrobial stewardship opportunities. Methods This retrospective, single center study included patients with a positive blood culture from May 2020 – January 2021. Polymicrobial cultures were excluded. Identification concordance was evaluated between ePlex® and MALDI-TOF, BD Phoenix™, and biochemical tests. Resistance mechanism/phenotypic susceptibility concordance was evaluated between ePlex® and BD PhoenixTM/ETEST®. MecA was assessed via oxacillin resistance, vanA via vancomycin resistance, CTX-M via ceftriaxone resistance, and KPC via carbapenem resistance. Opportunities for antimicrobial stewardship were also quantified. Results The overall identification concordance rate in 1276 positive blood cultures was 98.2%, with rates of 98.5%, 98.1%, and 93.3% for Gram-positive, Gram-negative, and fungal isolates, respectively. In 381 staphylococcal isolates, concordance rates were 98.3% and 100% for the presence and absence of mecA. Both the presence and absence of vanA were 100% concordant in 63 enterococcal isolates. CTX-M and KPC were evaluated in 189 Enterobacterales. Concordance rates were 96.8% for the presence of CTX-M and 60% for the presence of KPC, demonstrating that 40% of carbapenem resistance was due to non-enzymatic mechanisms. Ceftriaxone and carbapenem susceptibility correlated with the absence of CTX-M and KPC, respectively, in 100% of cultures. A majority of ePlex results (69.5%) represented opportunities for potential antimicrobial stewardship intervention. Conclusion High concordance rates between ePlex® and standard identification and susceptibility testing methods enable rapid antimicrobial optimization. Numerous opportunities for antimicrobial stewardship were identified based on ePlex® results. Disclosures All Authors: No reported disclosures

1275. Impact of a bundled antimicrobial stewardship intervention leveraging frontline pharmacist response to rapid blood culture diagnostics at an academic medical center and community hospital

Abstract Background Rapid Blood Culture Identification (BCID) panels have been shown to improve patient outcomes, including mortality and length of stay, when paired with antimicrobial stewardship (ASP) intervention. We report the results of a quality improvement initiative to expand to 24/7 pharmacist response to BCID results in a large academic medical center and a community hospital within the same health system. Methods A pre/post review was performed following a bundled stewardship intervention. Prior to the intervention, BCID results were addressed by the antimicrobial stewardship team Monday through Friday between 8am and 4pm. The bundled ASP intervention consisted of standardized treatment guidance, clinical education on result interpretation, frontline pharmacist evaluation of BCID results during off-peak hours to provide 24/7 response, and electronic health record documentation at each site. Clinical and microbiological data were collected for all patients. The primary outcome was time to optimal therapy (TTOT) for patients with a positive BCID within the first 72 hours of hospital admission. The secondary outcome assessed observed to expected length of stay (O/E LOS) ratios based on Vizient® Clinical Database estimates. The pre-intervention period included patients with a positive BCID between 1/1/2021 and 10/14/2022. The post-intervention period included patients with a positive BCID between 1/3/2023 and 3/31/2023. Results Clinical data and outcomes are reported in Table 1. During the first three months following ASP intervention, TTOT decreased at the academic medical center (15.0 to 6.4 hours) but did not change at the community hospital (25.9 to 25.1 hours). The O/E LOS ratio decreased for the academic medical center from 0.92 to 0.78 while the O/E LOS remained similar (0.85 to 0.83) for the community hospital. Conclusion A bundled ASP intervention utilizing frontline, non-ASP pharmacist review and prescriber outreach of BCID results quickly adopted. The intervention demonstrated benefit in the academic medical center, including quicker time to appropriate therapy and reduced length of hospitalization. Additional interventions may be needed for community sites depending on existing resources, staffing models and pharmacist/physician experience. Disclosures Nathaniel J. Rhodes, PharmD MS, Third Pole Therapeutics: Advisor/Consultant

152. Impact of BioFire FilmArray Blood Culture Identification Panel 2 (BCID2) and Antimicrobial Stewardship Interventions on Time to Optimal Antimicrobial Therapy in Patients with Positive Blood Cultures

Abstract Background Delayed treatment of bloodstream infections is associated with increased morbidity and mortality. Conventional methods for organism identification and susceptibility data from blood cultures can take about 2-5 days. Technological advancements in gene-based polymerase chain reaction tests amplify DNA targets from positive blood cultures and can shorten the identification time of certain organisms and resistance genes, aiding in earlier optimization of antimicrobial therapy. Methods This pre/post quasi-experimental, single center study was conducted 6 months prior to and 6 months after implementation of the BCID2 panel. Patients with at least 1 positive blood culture with an organism on the BCID2 panel were included in the study. One hundred twenty-five patients were included in the pre-BCID2 arm and 114 patients in the BCID2 arm. In the BCID2 panel group, real-time alerts were received by the antimicrobial stewardship team (AST) and recommendations were made to providers. The primary outcomes were time to pathogen identification, effective therapy, and optimal therapy. Results Demographic characteristics were similar in both groups. A higher percentage of patients with multiple risk factors for bacteremia were identified in the pre-BCID2 arm (36.8% vs 20.2%). The mean time to pathogen identification (60 hrs vs 30 hrs; P &amp;lt; 0.0001) and time to optimal therapy (61.4 hrs vs 44.6 hrs; P=0.001) were shorter in the BCID2 arm compared to the pre-BCID2 arm. Patients in the BCID2 arm had an overall trend toward decreased mean time to effective therapy compared with the pre-BCID2 arm (17.5 hours vs. 14 hours; P=0.18). Subgroup analysis of blood cultures with vancomycin-resistant Enterococcus spp., ESBL-producing organisms, and Candida glabrata met statistical significance in all three primary outcomes. The BCID2 arm had a 21.9 hr. reduction in time to pathogen ID (49.6 v. 27.7; P=0.02), 38.9 hr. reduction in time to effective therapy (66.9 vs. 28; P=0.013), and a 54.5 hr. reduction in time to optimal therapy (89.3 vs 34.8; P=0.046). Overall, 99% of recommendations from the AST were accepted by providers. Primary Outcome Results Time to pathogen ID, Time to Effective Therapy, Time to Optimal Therapy Secondary Outcomes 1 Total length of stay, ICU length of stay, Microbiologic Cure Secondary Outcomes 2 30 day Mortality and Recurrent bacteremia Conclusion Implementation of the BCID2 panel significantly decreased time to pathogen identification and optimal therapy in patients with bacteremia. Disclosures All Authors: No reported disclosures

176. Impact of Rapid Blood Culture Identification Panel on Antibiotic Treatment and Clinical Outcomes in Bloodstream Infections, Particularly Those Associated with Multidrug-resistant Microorganisms

Abstract Background The FilmArray Blood Culture Identification (BCID) panel (BioFire Diagnostics, USA) can detect 19 bacteria, five Candida spp., and three antimicrobial resistance determinants (mecA, vanA/B, and bla-KPC). This study evaluated the impact of BCID on the time to effective antibiotic administration and clinical outcomes in bloodstream infections, particularly carbapenem-resistant Enterobacterales (CRE), vancomycin-resistant enterococci (VRE) and carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia. Methods The clinical outcomes and time to effective antibiotic administration for bloodstream infections were retrospectively compared between patients who had undergone BCID testing and conventional culture method (control group). Further, we compared the 30-day mortality and time to effective antibiotic administration between BCID and conventional methods in CRE, CRAB, and VRE bacteremia. Results We compared 144 and 214 patients who had undergone BCID testing and the conventional culture method, respectively. The median time until the administration of effective antibiotics (3 h for both BCID and conventional culture, P = 0.789), appropriate antibiotics (BCID: 37 h vs. conventional culture: 44 h, P = 0.727), and 30-day mortality (BCID: 9.7% vs. conventional culture: 10.7%, P = 0.755) did not differ significantly between the groups. Multivariable analysis revealed that BCID was not associated with 30-day mortality after adjusting for Pitt bacteremia and Charlson comorbidity index (adjusted OR: 0.833, CI: 0.398–1.743) (Table 1). BCID did not reduce the risk of 30-day mortality in any subgroup: patients with ICU stay, hematologic department admissions, hospital-acquired infections, gram-positive and gram-negative bacteremia. Time to effective antibiotic administration was significantly reduced on using BCID in patients with CRE and VRE bacteremia, while no difference was observed in patients with CRAB bacteremia (Table 2). Conclusion BCID did not improve the clinical outcomes of overall bloodstream infections. However, it contributed to the early administration of effective antibiotics in patients with CRE and VRE bacteremia. BCID may be useful in selected patients in whom infection with multidrug-resistant microorganism is suspected. Disclosures All Authors: No reported disclosures

The Impact of the Rapid Blood Culture Identification Panel on Antibiotic Treatment and Clinical Outcomes in Bloodstream Infections, Particularly Those Associated with Multidrug-Resistant Micro-Organisms

We evaluated the impact of the FilmArray blood culture identification (BCID) panel on the time taken to administer effective antibiotics and the clinical outcomes of bloodstream infections. We retrospectively screened patients with bloodstream infections who underwent BCID testing and compared them to a historical control group that received conventional culture testing. A total of 144 and 214 patients who underwent BCID and conventional cultures, respectively, were compared. The 30-day mortality (BCID: 9.7% vs. conventional method: 10.7%, p = 0.755), time to effective antibiotic administration (3 h for both BCID and conventional method, p = 0.789), and time to appropriate antibiotic administration did not differ significantly between the groups. BCID was not significantly associated with 30-day mortality after adjusting for the Pitt bacteremia score and the Charlson comorbidity index (adjusted OR = 0.833, CI; 0.398–1.743). Compared with conventional methods, BCID reduced the time to administration of effective antibiotics in cases of carbapenem-resistant Enterobacterales (CRE) (39 h vs. 93 h, p = 0.012) and vancomycin-resistant enterococci (VRE) (50 h vs. 92 h, p &lt; 0.001) bacteremia. BCID did not affect the clinical outcomes of overall bloodstream infections; however, it contributed to the early administration of effective antibiotics in cases of CRE and VRE bacteremia.

The Significance of FilmArray Blood Culture Identification Panel (FA-BCID) for Managing Patients with Positive Blood Cultures.

We analyzed the accuracy and time efficiency of the FilmArray blood culture identification (FA-BCID) panel in identifying the pathogens in positive blood cultures. Two-hundred and seventy-two individuals were randomly assigned as the control (n = 212) and FA-BCID (n = 60) groups participating in this study. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was used to assess the control group. Meanwhile, the FA-BCID group was evaluated using both FA-BCID and MALDI-TOF, and the results were compared. The identification results from 73% (44/60) of the blood samples demonstrated agreement between FA-BCID and MALDI-TOF. The FA-BCID panel detected mecA genes in seven Staphylococcus species; six cases were confirmed using antimicrobial susceptibility testing. In addition, KPC genes were detected in one Escherichia coli and one Klebsiella pneumoniae, although only the latter corresponded with the result from antimicrobial susceptibility testing. The turnaround time (TAT) for identification through FA-BCID was shorter, with a median of 3.6 [2.4-4.6] hours (p < 0.05). No significant differences in the clinical and microbial outcomes following the ASP were observed between FA-BCID and MALDI-TOF. These results suggest that the FA-BCID panel provides an identification result that is as reliable as that provided by the routine identification procedure but with shorter TAT; thus, the FA-BCID method is considered an effective and beneficial method for therapeutic decision making and the improvement of the ASP for patients with bloodstream infection.

Identification of microorganisms by a rapid PCR panel from positive blood cultures leads to faster optimal antimicrobial therapy – a before-after study

BackgroundThe BioFire® FilmArray® Blood Culture Identification Panel 1 (BF-FA-BCIP) detects microorganisms with high accuracy in positive blood cultures (BC) – a key step in the management of patients with suspected bacteraemia. We aimed to compare the time to optimal antimicrobial therapy (OAT) for the BF-FA-BCIP vs. standard culture-based identification.MethodsIn this retrospective single-centre study with a before-after design, 386 positive BC cases with identification by BF-FA-BCIP were compared to 414 controls with culture-based identification. The primary endpoint was the time from BC sampling to OAT. Secondary endpoints were time to effective therapy, length of stay, (re-)admission to ICU, in-hospital and 30-day mortality. Outcomes were assessed using Cox proportional hazard models and logistic regressions.ResultsBaseline characteristics of included adult inpatients were comparable. Main sources of bacteraemia were urinary tract and intra-abdominal infection (19.2% vs. 22.0% and 16.8% vs. 15.7%, for cases and controls, respectively). Median (95%CI) time to OAT was 25.5 (21.0–31.2) hours with BF-FA-BCIP compared to 45.7 (37.7–51.4) hours with culture-based identification. We observed no significant difference for secondary outcomes.ConclusionsRapid microorganism identification by BF-FA-BCIP was associated with a median 20-h earlier initiation of OAT in patients with positive BC. No impact on length of stay and mortality was noted.Trial registrationClinicaltrials.gov, NCT04156633, registered on November 5, 2019.

Diagnostic efficiency of the FilmArray blood culture identification (BCID) panel: a systematic review and meta-analysis.

Introduction. The FilmArray blood culture identification panel (BCID) panel is a multiplex PCR assay with high sensitivity and specificity to identify the most common pathogens in bloodstream infections (BSIs).Hypothesis. We hypothesize that the BCID panel has good diagnostic performance for BSIs and can be popularized in clinical application.Aim: To provide summarized evidence for the diagnostic accuracy of the BCID panel for the identification of positive blood cultures.Methodology. We searched the MEDLINE, EMBASE and Cochrane databases through March 2021 and assessed the efficacy of the diagnostic test of the BCID panel. We performed a meta-analysis and calculated the summary sensitivity and specificity of the BCID panel. Systematic review protocols were registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42021239176).Results. A total of 16 full-text articles were eligible for analysis. The overall sensitivities of the BCID panel on Gram-positive bacteria, Gram-negative bacteria and fungi were 97 % (95 % CI, 0.96-0.98), 100 % (95 % CI, 0.98-01.00) and 99 % (95 % CI, 0.87-1.00), respectively. The pooled diagnostic specificities were 99 % (95 % CI, 0.97-1.00), 100 % (95 % CI, 1.00-1.00) and 100 % (95 % CI, 1.00-1.00) for Gram-positive bacteria, Gram-negative bacteria and fungi, respectively.Conclusions. The BCID panel has high rule-in value for the early detection of BSI patients. The BCID panel can still provide valuable information for ruling out bacteremia or fungemia in populations with low pretest probability.

Microbiological Assessment of the FilmArray Blood Culture Identification 2 Panel: Potential Impact in Critically Ill Patients.

Rapid pathogen detection and characterization from positive blood cultures are crucial in the management of patients with bloodstream infections (BSI) and in achieving their improved outcomes. In this context, the FilmArray Blood Culture Identification (BCID2) panel is an FDA approved molecular test, which can quickly identify different species and resistance determinants, thus making an impact in antimicrobial practice. In this study, we analyzed 136 positive blood cultures collected from septic critically ill patients from April 2021 to March 2023 by using the FilmArray BCID2 panel, and results obtained by fast molecular analysis were compared to those obtained by routine protocols. Overall, the BCID2 panel showed a strong concordance with conventional methods, particularly in the case of monomicrobial samples, whereas some discrepancies were found in 10/32 polymicrobial samples. Of note, this technique allowed us to identify a significant number of yeasts (37/94 samples) and to unravel the presence of several resistance markers, including both Gram-positive and Gram-negative organisms. These findings strongly support the potential use of the BCID2 panel as an adjunct to the conventional microbiology methods for the management of critically ill septic patients, thus accelerating blood pathogen and resistance genes identification, focusing antibiotic therapy, and avoiding inappropriate and excessive use of drugs.

Influence of Multiplex PCR in the Management of Antibiotic Treatment in Patients with Bacteremia.

The multiplex PCR assay can be a helpful diagnostic tool for patients with bacteremia. Herein, we assessed the impact of a Blood Culture Identification Panel (BCID) on both the diagnosis and treatment of patients with bacteremia. We performed a retrospective study using laboratory and clinical data to evaluate the impact of syndromic testing using a multiplex PCR testing system (BioFire® FilmArray) for the management of patients with bloodstream infections. BCID detected the pathogen in 102 (87.9%) samples out of the 116 positive blood cultures tested. The average time from the blood culture collection to the communication of the molecular test result was 23.93 h (range: 10.67-69.27 h). The main pathogen detected was Klebsiella pneumoniae (17.6%). The antimicrobial therapy was changed in accordance with the BCID results in 28 (40.6%) out of the 69 cases, wherein the treatment could have been theoretically adjusted. This allowed the adjustment of the therapy to be performed 1305.1 h faster than it would have been possible if conventional diagnostic methods had been used; this was the case for only 35.1% of the time gained if treatment was adjusted for all patients with positive BCID. Thus, although molecular tests can make a difference in the management of bloodstream infections, there is room for improvement in the clinical application of BCID results.

Usefulness of the FilmArray blood culture identification panel for identifying causative pathogens of bone and joint infections

As bone and joint infections (BJIs) require long-term treatment, identifying their causative pathogens is vital. However, the detection rate of conventional culturing remains inadequate. This study aimed to evaluate the usefulness of the FilmArray blood culture identification (BCID) panel for identifying causative pathogens in patients with BJIs. We tested a BCID panel using collected samples, in addition to conventional cultures. The primary outcome was to evaluate the diagnostic performance of the BCID panel, calculated using conventional culturing methods. A total of 44 patients who underwent BJI-related specimen collection were enrolled. Of the 44 patients, 22 were diagnosed with a BJI. Conventional culture identified 15 of 22 organisms (68.2%), whereas the BCID panel identified 14 of 22 organisms (63.4%). The overall sensitivity and specificity of the BCID panel were 73.3% and 57.1%, respectively, compared to those of the conventional culture. However, the sensitivity reached 100% when only pathogens included in the BCID panel were considered. In seven culture-negative cases, the BCID panel identified three organisms (42.9%). The BCID panel also indicated the appropriate therapy against a BJI caused by methicillin-resistant Staphylococcus aureus by detecting the mecA gene. This study demonstrated that the BCID panel has the potential for early and accurate diagnosis of the causative organism of BJI using specimens such as joint fluid and bone tissue. Our results suggest that BCID panels, in addition to routine culture, may improve our ability to diagnose the causative microorganisms of BJI in clinical practice, thereby contributing to the selection of appropriate antimicrobial agents.

Impact of Adding a Rapid PCR-Based Blood Culture Identification Panel to the Antimicrobial Stewardship Program of Patients with Febrile Neutropenia in a Peruvian Referral Hospital.

The addition of Biofire® FilmArray® Blood Culture Identification panel 2 (BCID2) to the antimicrobial stewardship program (ASP) could improve outcomes in bloodstream infections (BSI) of patients with febrile neutropenia (FN). A pre- and post-quasi-experimental single-center study was conducted at a reference hospital in Peru. Three groups were considered: patients with BSI before ASP intervention (control group), patients with BSI after ASP intervention (group 1), and patients with BSI after ASP intervention plus BCID2 PCR Panel implementation (group 2). Overall, 93 patients were identified (32 control, 30 group 1, 31 group 2). The median time to effective therapy was significantly shorter in group 2 compared to group 1 and control group, respectively (3.75 vs. 10 h, p = 0.004; 3.75 vs. 19 h, p < 0.001). No significant differences in terms of relapse of bacteremia, in-hospital mortality (all cause), and 30-day-all-cause hospital readmission between the three study periods were found. The appropriateness of empirical antimicrobial use, adding or change, and the following de-escalation or discontinuation was significant when the two intervention periods were compared with the control group (p < 0.001). In addition to the lack of local studies documenting the microbiological profile of FN episodes, adding syndromic panels-based testing could allow for the consolidation of ASP strategies.

Clinical outcomes associated with blood-culture contamination are not affected by utilization of a rapid blood-culture identification system.

Contaminated blood cultures result in extended hospital stays and extended durations of antibiotic therapy. Rapid molecular-based blood culture testing can speed positive culture detection and improve clinical outcomes, particularly when combined with an antimicrobial stewardship program. We investigated the impact of a multiplex polymerase chain reaction (PCR) FilmArray Blood Culture Identification (BCID) system on clinical outcomes associated with contaminated blood cultures. We conducted a retrospective cohort study involving secondary data analysis at a single institution. In this before-and-after study, patients with contaminated blood cultures in the period before PCR BCID was implemented (ie, the pre-PCR period; n = 305) were compared to patients with contaminated blood cultures during the period after PCR BCID was implemented (ie, the post-PCR implementation period; n = 464). The primary exposure was PCR status and the main outcomes of the study were length of hospital stay and days of antibiotic therapy. We did not detect a significant difference in adjusted mean length of hospital stay before (10.8 days; 95% confidence interval [CI], 9.8-11.9) and after (11.2 days; 95% CI, 10.2-12.3) the implementation of the rapid BCID panel in patients with contaminated blood cultures (P = .413). Likewise, adjusted mean days of antibiotic therapy between patients in pre-PCR group (5.1 days; 95% CI, 4.5-5.7) did not significantly differ from patients in post-PCR group (5.3 days; 95% CI, 4.8-5.9; P = .543). The introduction of a rapid PCR-based blood culture identification system did not improve clinical outcomes, such as length of hospital stay and duration of antibiotic therapy, in patients with contaminated blood cultures.