Randomized Trial of Rapid Multiplex Polymerase Chain Reaction-Based Blood Culture Identification and Susceptibility Testing

Ritu Banerjee, Christine B. Teng, Scott A. Cunningham, Sherry M. Ihde, James M. Steckelberg, James P. Moriarty, Nilay D Shah, Jayawant Mandrekar, Robin Patel

Research output: Contribution to journalArticle

162 Citations (Scopus)

Abstract

Background.The value of rapid, panel-based molecular diagnostics for positive blood culture bottles (BCBs) has not been rigorously assessed. We performed a prospective randomized controlled trial evaluating outcomes associated with rapid multiplex PCR (rmPCR) detection of bacteria, fungi, and resistance genes directly from positive BCBs. Methods.A total of 617 patients with positive BCBs underwent stratified randomization into 3 arms: standard BCB processing (control, n = 207), rmPCR reported with templated comments (rmPCR, n = 198), or rmPCR reported with templated comments and real-time audit and feedback of antimicrobial orders by an antimicrobial stewardship team (rmPCR/AS, n = 212). The primary outcome was antimicrobial therapy duration. Secondary outcomes were time to antimicrobial de-escalation or escalation, length of stay (LOS), mortality, and cost. Results.Time from BCB Gram stain to microorganism identification was shorter in the intervention group (1.3 hours) vs control (22.3 hours) (P <. 001). Compared to the control group, both intervention groups had decreased broad-spectrum piperacillin-tazobactam (control 56 hours, rmPCR 44 hours, rmPCR/AS 45 hours; P =. 01) and increased narrow-spectrum β-lactam (control 42 hours, rmPCR 71 hours, rmPCR/AS 85 hours; P =. 04) use, and less treatment of contaminants (control 25%, rmPCR 11%, rmPCR/AS 8%; P =. 015). Time from Gram stain to appropriate antimicrobial de-escalation or escalation was shortest in the rmPCR/AS group (de-escalation: rmPCR/AS 21 hours, control 34 hours, rmPCR 38 hours, P <. 001; escalation: rmPCR/AS 5 hours, control 24 hours, rmPCR 6 hours, P =. 04). Groups did not differ in mortality, LOS, or cost. Conclusions.rmPCR reported with templated comments reduced treatment of contaminants and use of broad-spectrum antimicrobials. Addition of antimicrobial stewardship enhanced antimicrobial de-escalation. Clinical Trials Registration.NCT01898208.

Original languageEnglish (US)
Pages (from-to)1071-1080
Number of pages10
JournalClinical Infectious Diseases
Volume61
Issue number7
DOIs
StatePublished - Oct 1 2015

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Multiplex Polymerase Chain Reaction
Blood Culture
Length of Stay
Costs and Cost Analysis
Lactams
Molecular Pathology
Mortality
Random Allocation

Keywords

  • antimicrobial stewardship
  • blood culture
  • diagnostic
  • PCR

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Randomized Trial of Rapid Multiplex Polymerase Chain Reaction-Based Blood Culture Identification and Susceptibility Testing. / Banerjee, Ritu; Teng, Christine B.; Cunningham, Scott A.; Ihde, Sherry M.; Steckelberg, James M.; Moriarty, James P.; Shah, Nilay D; Mandrekar, Jayawant; Patel, Robin.

In: Clinical Infectious Diseases, Vol. 61, No. 7, 01.10.2015, p. 1071-1080.

Research output: Contribution to journalArticle

Banerjee, Ritu ; Teng, Christine B. ; Cunningham, Scott A. ; Ihde, Sherry M. ; Steckelberg, James M. ; Moriarty, James P. ; Shah, Nilay D ; Mandrekar, Jayawant ; Patel, Robin. / Randomized Trial of Rapid Multiplex Polymerase Chain Reaction-Based Blood Culture Identification and Susceptibility Testing. In: Clinical Infectious Diseases. 2015 ; Vol. 61, No. 7. pp. 1071-1080.
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AU - Cunningham, Scott A.

AU - Ihde, Sherry M.

AU - Steckelberg, James M.

AU - Moriarty, James P.

AU - Shah, Nilay D

AU - Mandrekar, Jayawant

AU - Patel, Robin

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N2 - Background.The value of rapid, panel-based molecular diagnostics for positive blood culture bottles (BCBs) has not been rigorously assessed. We performed a prospective randomized controlled trial evaluating outcomes associated with rapid multiplex PCR (rmPCR) detection of bacteria, fungi, and resistance genes directly from positive BCBs. Methods.A total of 617 patients with positive BCBs underwent stratified randomization into 3 arms: standard BCB processing (control, n = 207), rmPCR reported with templated comments (rmPCR, n = 198), or rmPCR reported with templated comments and real-time audit and feedback of antimicrobial orders by an antimicrobial stewardship team (rmPCR/AS, n = 212). The primary outcome was antimicrobial therapy duration. Secondary outcomes were time to antimicrobial de-escalation or escalation, length of stay (LOS), mortality, and cost. Results.Time from BCB Gram stain to microorganism identification was shorter in the intervention group (1.3 hours) vs control (22.3 hours) (P <. 001). Compared to the control group, both intervention groups had decreased broad-spectrum piperacillin-tazobactam (control 56 hours, rmPCR 44 hours, rmPCR/AS 45 hours; P =. 01) and increased narrow-spectrum β-lactam (control 42 hours, rmPCR 71 hours, rmPCR/AS 85 hours; P =. 04) use, and less treatment of contaminants (control 25%, rmPCR 11%, rmPCR/AS 8%; P =. 015). Time from Gram stain to appropriate antimicrobial de-escalation or escalation was shortest in the rmPCR/AS group (de-escalation: rmPCR/AS 21 hours, control 34 hours, rmPCR 38 hours, P <. 001; escalation: rmPCR/AS 5 hours, control 24 hours, rmPCR 6 hours, P =. 04). Groups did not differ in mortality, LOS, or cost. Conclusions.rmPCR reported with templated comments reduced treatment of contaminants and use of broad-spectrum antimicrobials. Addition of antimicrobial stewardship enhanced antimicrobial de-escalation. Clinical Trials Registration.NCT01898208.

AB - Background.The value of rapid, panel-based molecular diagnostics for positive blood culture bottles (BCBs) has not been rigorously assessed. We performed a prospective randomized controlled trial evaluating outcomes associated with rapid multiplex PCR (rmPCR) detection of bacteria, fungi, and resistance genes directly from positive BCBs. Methods.A total of 617 patients with positive BCBs underwent stratified randomization into 3 arms: standard BCB processing (control, n = 207), rmPCR reported with templated comments (rmPCR, n = 198), or rmPCR reported with templated comments and real-time audit and feedback of antimicrobial orders by an antimicrobial stewardship team (rmPCR/AS, n = 212). The primary outcome was antimicrobial therapy duration. Secondary outcomes were time to antimicrobial de-escalation or escalation, length of stay (LOS), mortality, and cost. Results.Time from BCB Gram stain to microorganism identification was shorter in the intervention group (1.3 hours) vs control (22.3 hours) (P <. 001). Compared to the control group, both intervention groups had decreased broad-spectrum piperacillin-tazobactam (control 56 hours, rmPCR 44 hours, rmPCR/AS 45 hours; P =. 01) and increased narrow-spectrum β-lactam (control 42 hours, rmPCR 71 hours, rmPCR/AS 85 hours; P =. 04) use, and less treatment of contaminants (control 25%, rmPCR 11%, rmPCR/AS 8%; P =. 015). Time from Gram stain to appropriate antimicrobial de-escalation or escalation was shortest in the rmPCR/AS group (de-escalation: rmPCR/AS 21 hours, control 34 hours, rmPCR 38 hours, P <. 001; escalation: rmPCR/AS 5 hours, control 24 hours, rmPCR 6 hours, P =. 04). Groups did not differ in mortality, LOS, or cost. Conclusions.rmPCR reported with templated comments reduced treatment of contaminants and use of broad-spectrum antimicrobials. Addition of antimicrobial stewardship enhanced antimicrobial de-escalation. Clinical Trials Registration.NCT01898208.

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