Rapid Blood Culture Research Articles

Health Economic Evaluation of Antimicrobial Stewardship, Procalcitonin Testing, and Rapid Blood Culture Identification in Sepsis Care: A 90-Day Model-Based, Cost-Utility Analysis.

We evaluated the cost-effectiveness of a bundled intervention including an antimicrobial stewardship program (ASP), procalcitonin (PCT) testing, and rapid blood culture identification (BCID), compared with pre-implementation standard care in critically ill adult patients with sepsis. We conducted a decision tree model-based cost-effectiveness analysis alongside a previously published pre- and post-implementation quality improvement study. We adopted a public Canadian healthcare payer's perspective. Two intensive care units in Alberta with 727 adult critically ill patients were included. Our bundled intervention was compared with pre-implementation standard care. We collected healthcare resource use and estimated unit costs in 2022 Canadian dollars (CAD) over a time horizon from study entry to hospital discharge or death. We calculated the incremental net monetary benefit (iNMB) of the intervention group compared with the pre-intervention group. The primary outcome was cost per sepsis case. Secondary outcomes included readmission rates, Clostridioides difficile infections, mortality, and lengths of stay. Uncertainty was investigated using cost-effectiveness acceptability curves, cost-effectiveness plane scatterplots, and sensitivity analyses. Mean (standard deviation [SD]) cost per index hospital admission was CAD $83,251 ($107,926) for patients in the intervention group and CAD $87,044 ($104,406) for the pre-intervention group, though the difference ($3,793 [$7,897]) was not statistically significant. Costs were higher in the pre-intervention group for antibiotics, readmissions, and C. difficile infections. The intervention group had a lower mean expected cost; $110,580 ($108,917) compared with pre-intervention ($125,745 [$113,210]), with a difference of $15,165 ($8278). There were no statistically significant differences in quality adjusted life years (QALYs) between groups. The iNMB of the intervention group compared with pre-intervention was greater than $15,000 for willingness-to-pay (WTP) per QALY values of between $0 and $100,000. In our sensitivity analysis, the intervention was most likely to be cost-effective in roughly 56% of simulations at all WTP thresholds. Our bundled intervention of ASP, PCT, and BCID among adult critically ill patients with sepsis was potentially cost-effective, but with substantial decision uncertainty.

An investigation of scattered light integrating collector technology for rapid blood culture sensitivity testing.

Introduction. Sepsis rates are increasing, with Gram-negative organisms representing a large proportion of bloodstream infections. Rapid antibiotic administration, alongside diagnostic investigations, is required for the effective management of these patients.Gap statement. Current diagnostics take ~48 h for a final report; therefore, rapid diagnostics are required.Aim. This study investigated a novel antibiotic sensitivity method, the scattered light integrating collector (SLIC), combined with a rapid identification method using matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) technology to determine if an accurate identification and susceptibility result can be provided within 4 h of a positive blood culture report.Methodology. A total of 47 blood cultures containing Gram-negative bacteria from 46 patients were processed using the MALDI-TOF Biotyper Sepsityper for identification directly from the blood and the SLIC instrument for susceptibility testing. All organisms were also tested using the current standard workflow used in the host laboratory. Categorical agreement (CA), major errors (MaEs) and very major errors (VMEs) were determined.Results. SLIC produced susceptibility results with a 71.9% CA, 30.6% MaE and 17.5% VME. The median difference in time to the final result was 44.14 (43 : 05-45 : 15) h earlier compared to the current method.Conclusion. We conclude that SLIC was unable to consistently provide sufficiently accurate antibiotic susceptibility results compared to the current standard method.

Early detection of bacteremia pathogens with rapid molecular diagnostic tests and evaluation of effect on intensive care patient management

İntroductionThe BioFire FilmArray Blood Culture Identification panel (BCID2), a rapid molecular blood culture identification test based on multiplex nested polymerase chain reaction. The aim of this study was to evaluate clinical outcomes between the period before (pre-BCID2 group) and after (post-BCID2 group) the introduction of the BCID2 panel into our routine practice. MethodsThe primary endpoint was time to optimal antibiotherapy, and the secondary endpoints were duration of hospital and intensive care unit stay, 7-day, 14-day and 28-day mortality rates after bacteremia. ResultsThe median time from empirical antibiotherapy to optimal antimicrobial therapy was 4560 (IQR;3060-7140) minutes in the pre-BCID2 group and 1715 (IQR;1362- 2776.25) minutes (in the post-BCID2 group (p<0.05). ConclusionAdding the BCID2 panel may improve antibiotic management in critically ill bacteremia patients

Opportunity for Early De-escalation in Enterobacterales Bacteremia with Rapid Blood Culture Identification Technology

Background: The BioFire FilmArray Blood Culture Identification 2 (BCID2) Panel is used to identify organisms present in positive blood cultures within hours of detection at Virginia Commonwealth University Health System (VCUHS). BCID2 is also able to detect common resistance mechanisms including CTX-M, the most common extended-spectrum beta-lactamase (ESBL) in the United States, and several carbapenemases. The Antimicrobial Stewardship Program (ASP) at VCUHS established optimal treatment recommendations for each organism identified by BCID2 based on the detection of a resistance mechanism and local resistance patterns. The recommendation for the majority of Enterobacterales without a detected resistance mechanism is ceftriaxone. However, providers are often reluctant to de-escalate antibiotics without confirmed susceptibility testing, as there may be other mechanisms of antibiotic resistance in Gram-negative organisms. The objective of this evaluation was to measure the degree of congruence between BCID2 resistance mechanism detection and susceptibility testing by disk diffusion, and to validate the adequacy of the VCUHS ASP BCID2 treatment recommendations for Enterobacterales bacteremia. Methods: Patients with positive Enterobacterales BCID2 results from March 12 to June 19, 2023 were retrospectively identified. Organisms identified by BCID2 that were considered high-risk for clinically significant AmpC production due to an inducible AmpC gene (i.e., K. aerogenes, E. cloacae complex) were excluded. Results: A total of 270 results were included. The most commonly identified organism was E. coli (n = 139, 51.5%), followed by K. pneumoniae (n = 74, 27.4%). There were 27 (10%) isolates positive for CTX-M and 1 (0.4%) isolate positive for KPC. All CTX-M isolates were ceftriaxone resistant, and the KPC isolate was meropenem resistant. The remaining 242 isolates were negative for all resistance markers detected by BCID2. Of these, only 3 (1.2%) were resistant to ceftriaxone and notably, 8 (3.3%) were resistant to piperacillin/tazobactam. Overall, BCID2 CTX-M detection was 90% sensitive and 100% specific for predicting ceftriaxone resistance in Enterobacterales. Conclusion: CTX-M detection by BCID2 is highly sensitive and specific for predicting ceftriaxone resistance in Enterobacterales. CTX-M negative isolates were more often susceptible to ceftriaxone than to piperacillin/tazobactam, which is commonly used as empiric therapy for Gram-negative organisms at our institution. This highlights an excellent opportunity for safe and effective early de-escalation of antibiotics for treatment of Enterobacterales bacteremia.

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.

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

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.

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.

Large-Scale Clinical Evaluation of Rapid Blood Culture Identification Panels for Bloodstream Infections at a Tertiary Hospital

The prompt implementation of optimal antibacterial therapy through the rapid identification of the causative organisms is essential for improving outcomes for critically ill patients with bloodstream infections. We evaluated the clinical performance of the FilmArray blood culture identification (BCID) panel for rapidly identifying causative pathogens in the bloodstream using large-scale clinical samples. We analyzed the results of identification using a BCID panel performed on 2005 positive blood culture bottles from September 2019 to June 2022. Pathogen detection efficiency and interval from Gram staining to identification using the BCID panel were compared to those of conventional identification systems-VITEK MS MALDI-TOF Mass Spectrometer and Vitek2-and antibiotic susceptibility testing-Vitek2. We detected 2167 isolates from 2005 positive blood culture bottles. In these isolates, the BCID panel showed 93% full agreement-both organisms and antimicrobial resistance genes were matched, and no off-target organisms were detected. Species-level discordance was found in 0.6% of tests. Sixty-five isolates (3.0%) were only detected by BCID, whereas 22 isolates (1.0%) from the on-target panel were not detected by BCID. This large-scale study demonstrated that the BCID panel was a reliable and rapid identification method for directly identifying bloodstream pathogens in a positive blood culture.

Test Performance and Potential Clinical Utility of the GenMark Dx ePlex Blood Culture Identification Gram-Negative Panel.

The test performance and potential clinical utility of the ePlex blood culture identification Gram-negative (BCID-GN) panel was evaluated relative to matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry on bacterial isolates and conventional antimicrobial susceptibility testing. The majority (106/108, 98.1%) of GN bacteria identified by MALDI were on the BCID-GN panel, and valid tests (107/108, 99.1%) yielded results on average 26.7 h earlier. For all valid tests with on-panel organisms, the positive percent agreement was 102/105 (97.2%) with 3 false negatives and the negative percent agreement was 105/105. Chart review (n = 98) showed that in conjunction with Gram stain results, negative pan-Gram-positive (GP) markers provided the opportunity to discontinue GP antibiotic coverage in 63/98 (64.3%) cases on average 26.2 h earlier. Only 8/12 (66.7%) Enterobacterales isolates with resistance to third-generation cephalosporins harbored the CTX-M gene. In contrast, 8/8 CTX-M+ samples yielded a resistant isolate. Detection of 1 Stenotrophomonas maltophilia (18 h), 1 OXA23/48+ Acinetobacter baumannii (52.4 h), and 3 CTX-M+ Enterobacterales isolates on ineffective treatment (47.1 h) and 1 on suboptimal therapy (72.6 h) would have additionally enabled early antimicrobial optimization in 6/98 (6.1%) patients. IMPORTANCE The GenMark Dx ePlex rapid blood culture diagnostic system enables earlier time to identification of antimicrobial-resistant Gram-negative bacteria causing bloodstream infections. Its ability to rule out Gram-positive bacteria enabled early discontinuation of unnecessary antibiotics in 63/98 (64.3%) cases on average 26.2 h earlier. Detection of bacteria harboring the CTX-M gene as well as early identification of highly resistant bacteria such as Stenotrophomonas maltophilia and Acinetobacter baumannii enabled optimization of ineffective therapy in 6/98 (6.1%) patients. Its implementation in clinical microbiology laboratories optimizes therapy and improves patient care.

188. Opportunities for antimicrobial stewardship: Time to optimal therapy and vancomycin use in gram-positive and contaminated blood cultures before and after implementation of rapid blood culture diagnostic testing

Abstract Background Rapid molecular diagnostic tests improve time to organism identification and may expedite antimicrobial de-escalation. Through faster detection of contaminated samples, rapid blood culture identification (BCID) should also reduce unnecessary antibiotic use. BioFire FilmArray BCID was implemented in July 2019 at a community hospital. This study compared antimicrobial use for gram-positive blood cultures before and after BCID implementation to identify areas for further antimicrobial stewardship intervention. Methods This retrospective cohort study evaluated adult patients at a 450-bed community hospital with gram-positive blood culture results between February and June 2018 and 2019 (pre-and post-BCID). Patients were excluded for polymicrobial bacteremia, pregnancy, or expiration/hospice status before blood culture positivity. The primary outcome was time to optimal therapy (TTOT) for bacteremia, defined as time to antimicrobial de-escalation, discontinuation, or result for untreated contaminated cultures. Time to organism identification, receipt of optimal therapy, and vancomycin duration were also evaluated, in addition to subgroup analysis of contaminated cultures (identified by microbiology comment or physician note). Results Of the 232 patients, median age was 70 years and 54.3% were male. Coagulase-negative staphylococci was most commonly isolated (n=104, 45%) and contamination rate was 53.4%. Median TTOT improved from 53.3 vs 28 hours, p&amp;lt; 0.001 in pre- vs post-groups, respectively, and optimal therapy selection increased from 83% to 93%, p=0.028. Median time to organism identification was 60.2 vs 23.5 hours, p&amp;lt; 0.001. Median duration for vancomycin (35.1 vs 25.2 hours, p=0.231) and overall antimicrobial duration did not differ between groups. Among contaminated blood cultures, TTOT improved (54 vs 27.3 hours, p&amp;lt; 0.001) and vancomycin median duration decreased (27.5 vs 16.6 hours, p=0.253). Conclusion Rapid BCID significantly improved TTOT, resulting in improved rates of optimal therapy and an observed reduced vancomycin duration. High rates of contaminated blood cultures identified opportunities for coordination with antimicrobial stewardship to reduce contamination rates and improve antimicrobial use. Disclosures All Authors: No reported disclosures.

203. When rapid molecular blood culture testing fails to identify the organism: microbiology and patient outcomes

Abstract Background Verigene™ is a rapid nucleic acid test used to optimize antibiotic selection on positive blood cultures but it does not detect all pathogens. The purpose of this project was to describe the organisms Verigene™ could not identify as well as the clinical outcomes of the patients. Methods This was a single-center, retrospective cohort study of patients who received a Verigene™ non-detected result from 5/19/20-6/30/21. The primary objective of this study was to identify the organisms and secondary objectives included any changes in antimicrobial therapy after the test result, appropriateness of change in therapy, discharge disposition, and 30-day readmission rate. Results A total of 85 of 958 (8.9%) Verigene results were non-detected during the time period. Among the 85 results included for the primary objective, six were determined to be contaminants by the clinicians. Among the remaining 79 results, 44 were anaerobic bacteria, 11 Serratia species, and 24 were other miscellaneous bacteria. Therapy was changed in 62 (78.5%) after the Verigene result. Overall antibiotic regimens were deemed appropriate after antibiotic changes were made from the final culture result in 70 of 79 (88.6%) cases. Twenty five of 79 (31.6%) patients died in the hospital. Among the 54 patients discharged, 11 (20.3%) were readmitted within 30 days including five (9.2%) due to infection. No cases of infectious readmission were due to the prior episode of bacteremia. Conclusion The majority of Verigene results that were not able to be identified were later identified to be anaerobic bacteria and Serratia species which are known limitations of the test. While most patients received appropriate therapy, there was a high mortality and readmission rate. Further studies should be performed to confirm this observation. Disclosures All Authors: No reported disclosures.

913. Impact of BioFire® FilmArray® Blood Culture Identification Panels on Time to Optimal Antimicrobial Therapy

Abstract Background Bloodstream infections are associated with significant morbidity, mortality, and costs. Timely initiation of effective treatment is required for optimal outcomes. Conventional microbiological techniques require 72 hours for organism identification; however, rapid blood culture identification (BCID) polymerase chain reaction (PCR) panels have expedited this process. At Atlantic Health System, the BioFire® FilmArray® BCID panel was implemented June 2020 (BCID1), with subsequent upgrade to BCID2 March 2021. Notable features of the BCID2 panel include speciation of Enterococcus spp. and the addition of the CTX-M target. The purpose of this study is to assess time to optimal therapy (TTOT) with and without the BCID platforms for select organisms. Table 1:Select Primary and Secondary Endpoints Methods This retrospective study of hospitalized, adult patients was conducted at two community teaching hospitals from 5/2019 to 12/2021. Patients with a blood culture positive for Enterococcus faecalis, E. faecium, Proteus spp., Escherichia coli, or non-aerogenes Klebsiella spp. were included. Patients with polymicrobial or presumed polymicrobial source of bacteremia, recent positive blood cultures, PCR not performed in BCID arms, or who were deceased/comfort care at time of Gram stain were excluded. The primary endpoint was TTOT. Secondary endpoints included time to effective therapy, duration of vancomycin, therapy modification 24 hours after Gram stain result, and length of stay. All analyses compared PreBCID to either BCID1 or BCID2 arm. Results Three hundred patients (100 per arm) were included. Patient characteristics were similar across study arms. The median Pitt Bacteremia Score was 1, the most common organism identified was E. coli (65%), the most common source of bacteremia was genitourinary (65%), and 11% of isolates produced ESBL. TTOT (days) was similar in PreBCID compared to BCID1 and BCID2 [(2.48 vs. 2.65, p=0.10); (2.48 vs. 2.37 days, p=0.27)]. TTOT was significantly longer in the gram-negative subgroup of the BCID1 arm compared to PreBCID (2.62 vs 1.85 days, p=0.03). See Table 1 for full analyses. Conclusion Implementation of the BCID panels did not reduce TTOT in select organisms at our institution. Barriers to benefit may include limited education and lack of formal antimicrobial stewardship team involvement. Disclosures All Authors: No reported disclosures.

900. Evaluation of automated blood culture results and subsequent pharmacist intervention on time to targeted therapy in patients with bacteremia

Abstract Background Bloodstream infections (BSIs) are associated with a high mortality rate and timely administration of empiric broad-spectrum antibiotics is critical. However, prolonged exposure increases the risk of colonization and subsequent infection with resistant bacteria. The use of rapid diagnostics and prospective audit and feedback allows for decreased time to targeted therapy and development of resistance. Methods This quasi-experimental study aimed to evaluate changes in time to targeted antibiotic therapy before and after implementation of a real-time pharmacist notification for bacteremic patients. The pre- and post- intervention periods were 9/1/19–12/31/19 and 9/1/21– 12/31/21, respectively. Bacteremic patients that were identified via automated Bruker’s MBT Sepsityper IVD kit reports and admitted for ≥48 hours were included in the study. Patients were excluded if they had ≥ 1 BSI or polymicrobial BSI during hospitalization, treatment of a concurrent infection, or transitioned to hospice. The primary outcome was change in time to targeted antibiotic therapy. Secondary outcomes included change in broad-spectrum antibiotic days of therapy, total duration therapy, hospital length of stay, and in-hospital all-cause mortality. Results A total of 132 charts were reviewed, 83 of which were included, with 47 in the pre- and 36 in the post-intervention group. The most common isolates in the study across both groups was E. coli (36.1%), Klebsiella spp. (15.7%), MSSA (15.7%) and MRSA (8.4%). A trend towards decreased time to targeted therapy was seen in the post-intervention group (5.4 hours vs 33.0 hours; p = 0.150). Median duration of anti-MRSA therapy was reduced from 49.4 hours in the pre-intervention group to 27.92 hours in the post-intervention group (p=0.035). There was no significant difference in total duration of therapy, days of anti-pseudomonal therapy, length of stay, or in-hospital all-cause mortality. Of the 22 pharmacist interventions, 18 (81.8%) were accepted. The most common pharmacist intervention was therapy de-escalation (72.7%). Conclusion Automated rapid blood culture diagnostic results used in conjunction with real-time notifications to pharmacists, further decreased time to targeted therapy and significantly reduced duration of anti-MRSA therapy. Disclosures All Authors: No reported disclosures.

#23 Clinical Outcomes with Rapid Gram-Positive Blood Culture Identification in an Academic Pediatric Hospital

Abstract Background BACKGROUND Delays in initiating appropriate antibiotics increases mortality, length of stay, and overall admissions costs in patients with bloodstream infections. Adult studies using rapid diagnostic tests such as the GenMark’s e-Plex Blood Culture Identification (BCID) Panels coupled with Antimicrobial Stewardship Program (ASP) interventions have led to reductions in each of these metrics. Similar data assessing use in the pediatric population are generally lacking. The primary aim of this study was to assess the impact of the GenMark Blood Culture Identification Gram Positive panel (BCID-GP panel) on the time to optimal antimicrobial therapy (OAT) in pediatric patients with positive blood cultures growing gram-positive bacteria (GPB). Method METHOD A 2-year Quality Improvement study of admitted pediatric patients was carried out at UPMC Children’s Hospital of Pittsburgh (CHP) between June 25, 2019 and June 26, 2021. Pre-intervention data (6/25/19 – 6/25/20) was collected retrospectively from the CHP Electronic Medical Record (EMR). During the post-intervention time-period (6/26/20 - 6/26/21), BCID-GP panel was run daily from 6AM to 10 PM on blood cultures with Gram stains revealing GPB. Results were provided to the ASP who generated recommendations and communicated them to the patient’s primary team after reviewing the EMR using a pre-determined algorithm. Statistical analyses were performed using Wilcoxon rank sum test and Chi-squared tests. Results RESULTS 317 and 265 blood cultures with GPB were evaluated in the pre- and post-intervention groups, with median ages of 2.26 and 3.2 years in the 2 groups, respectively. Overall panel accuracy was 97% with gene accuracy of 100%. Percent compliance with ASP recommendations within 12 hours was 89%. The median time to OAT was 48 (range of 0-175), and 33.1 hours (range 0-165) in the pre- and post-intervention groups, respectively (p &amp;lt;0.001). The median time to OAT for patients with MSSA decreased from 65 to 30.5 hours (p &amp;lt;0.001), and 37 to 20 hours (p 0.048) for those with MRSA. Antibacterial therapy was avoided in 42.2% of patients in the post-intervention group when results were interpreted as contaminants, compared with 23.4% in the pre-intervention group with this assessment (p = 0.008). Length of stay and 30-day mortality was similar between groups, 6.1 days vs 6.9 days (p = 0.23) and 3.5% vs 3.4%, (p = 1.00) respectively. Conclusion CONCLUSION Use of BCID-GP panel significantly decreased the time to OAT and avoided initiation of antibiotics in incidences of contamination in our study population. This was also true for positive blood cultures due to MSSA and MRSA. However, significant differences in the length of stay or 30-day mortality were not identified between groups. We did find the overall accuracy, defined as the percentage of BCID panels detected targets confirmed by conventional laboratory culture and gene accuracy, defined as the percent of BCID panels with results detected confirmed by conventional laboratory susceptibility methods, of the panel mirrored with previously published data. We also found ASP recommendations based on the BCID-GP were followed 89% of the time within 12 hours of them being made.

Case report on typhoid fever

An Eight-year-old boy with high grade fever, abdominal pain and vomiting suspected for typhoid and diagnose by serological test (rapid card test), urine analysis and blood culture were also performed. Rapid card test is very helpful for the detection of IgG and IgM antibodies present in the body in 15-30 minutes of time. With rapid card test and blood culture the patient was diagnosed with typhoid fever. The Ceftriaxone antibiotic was given to patient intravenously for 5 days and the patient recovered. Keywords: enteric fever; typhoid fever; blood culture; serology for typhoid.

EUCAST rapid antibiotic susceptibility testing method for blood cultures – Implementation in a private laboratory setting

Introduction: The European Committee on Antimicrobial Susceptibility Testing (EUCAST) Rapid Antimicrobial Susceptibility Testing (RAST) method has recently made rapid blood culture reporting possible for 8 common organisms (Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecalis/faecium, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii).1,2 The implementation of this method was evaluated over a 6-month period.

A comparison of active versus passive methods of responding to rapid diagnostic blood culture results.

To compare 2 methods of communicating polymerase chain reaction (PCR) blood-culture results: active approach utilizing on-call personnel versus passive approach utilizing notifications in the electronic health record (EHR). Retrospective observational study. A tertiary-care academic medical center. Adult patients hospitalized with ≥1 positive blood culture containing a gram-positive organism identified by PCR between October 2014 and January 2018. The standard protocol for reporting PCR results at baseline included a laboratory technician calling the patient's nurse, who would report the critical result to the medical provider. The active intervention group consisted of an on-call pager system utilizing trained pharmacy residents, whereas the passive intervention group combined standard protocol with real-time in-basket notifications to pharmacists in the EHR. Of 209 patients, 105, 61, and 43 patients were in the control, active, and passive groups, respectively. Median time to optimal therapy was shorter in the active group compared to the passive group and control (23.4 hours vs 42.2 hours vs 45.9 hours, respectively; P = .028). De-escalation occurred 12 hours sooner in the active group. In the contaminant group, empiric antibiotics were discontinued faster in the active group (0 hours) than in the control group and the passive group (17.7 vs 7.2 hours; P = .007). Time to active therapy and days of therapy were similar. A passive, electronic method of reporting PCR results to pharmacists was not as effective in optimizing stewardship metrics as an active, real-time method utilizing pharmacy residents. Further studies are needed to determine the optimal method of communicating time-sensitive information.