1887

Abstract

Purpose. In this field trial of rapid blood culture identification (BCID), we aimed to determine whether the improved speed and accuracy of specific BCID predicted in our earlier pilot study could be obtained in regional hospitals by deploying a multiplex PCR FilmArray (Biomerieux, France) capability in their laboratories.

Methods. We trained local hospital laboratory staff to operate the FilmArray equipment and act on the results. To do this, we integrated the multiplex PCR into the standard laboratory blood culture workflow and reporting procedure.

Results. Of 100 positive blood culture episodes, BCID FilmArray results were correct in all 42 significant monobacterial cultures, with a fully predictive identity in 38 (90.5 %) and a partial identity in another four (9.5 %). There was one major error; a false positive Pseudomonas aeruginosa. The minor errors were the detection of one methicillin-resistant Staphylococcus aureus, which proved to be a methicillin-sensitive S. aureus mixed with a methicillin-resistant coagulase-negative staphylococcus, five false negative coagulase-negative staphylococci and one false negative streptococcus species. We found that 41/49 (84 %) clinically significant mono- and polymicrobial culture results were fully predictive of culture-based identification to bacterial species level at a mean of 1.15 days after specimen collection.

Conclusions. There was a reduction of 1.21 days in the time taken to produce a definitive BCID compared to the previous year, translating into earlier communication of more specific blood culture results to the treating physician. Reduced time to definitive blood culture results has a direct benefit for isolated Australian communities at great distances from specialist hospital services.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000714
2018-03-13
2019-10-15
Loading full text...

Full text loading...

/deliver/fulltext/jmm/67/5/669.html?itemId=/content/journal/jmm/10.1099/jmm.0.000714&mimeType=html&fmt=ahah

References

  1. Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ et al. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med 2017;376:2235–2244 [CrossRef][PubMed]
    [Google Scholar]
  2. Chaudhary T, Hohenstein C, Bayer O. The golden hour of sepsis: initial therapy should start in the prehospital setting. Med Klin Intensivmed Notfmed 2014;109:104–108 [CrossRef][PubMed]
    [Google Scholar]
  3. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:1589–1596 [CrossRef][PubMed]
    [Google Scholar]
  4. de Groot B, Ansems A, Gerling DH, Rijpsma D, van Amstel P et al. The association between time to antibiotics and relevant clinical outcomes in emergency department patients with various stages of sepsis: a prospective multi-center study. Crit Care 2015;19:194 [CrossRef][PubMed]
    [Google Scholar]
  5. O’Neill J. Tackling drug resistant infections globally: final report and recommendations. In The Review on Antimicrobial Resistance Westminster, UK: HM Government; 2016
    [Google Scholar]
  6. Buehler SS, Madison B, Snyder SR, Derzon JH, Cornish NE et al. Effectiveness of practices to increase timeliness of providing targeted therapy for inpatients with bloodstream infections: a laboratory medicine best practices systematic review and meta-analysis. Clin Microbiol Rev 2016;29:59–103 [CrossRef][PubMed]
    [Google Scholar]
  7. Inglis TJ, Bzdyl N, Chua IL, Urosevic NM, Leung MJ et al. Improved blood culture identification by FilmArray in cultures from regional hospitals compared with teaching hospital cultures. J Med Microbiol 2016;65:56–61 [CrossRef][PubMed]
    [Google Scholar]
  8. Fiori B, D'Inzeo T, Giaquinto A, Menchinelli G, Liotti FM et al. Optimized Use of the MALDI BioTyper system and the FilmArray BCID panel for direct identification of microbial pathogens from positive blood cultures. J Clin Microbiol 2016;54:576–584 [CrossRef][PubMed]
    [Google Scholar]
  9. Salimnia H, Fairfax MR, Lephart PR, Schreckenberger P, Desjarlais SM et al. Evaluation of the FilmArray blood culture identification panel: results of a multicenter controlled trial. J Clin Microbiol 2016;54:687–698 [CrossRef][PubMed]
    [Google Scholar]
  10. Martinez RM, Bauerle ER, Fang FC, Butler-Wu SM. Evaluation of three rapid diagnostic methods for direct identification of microorganisms in positive blood cultures. J Clin Microbiol 2014;52:2521–2529 [CrossRef][PubMed]
    [Google Scholar]
  11. Ward C, Stocker K, Begum J, Wade P, Ebrahimsa U et al. Performance evaluation of the Verigene® (Nanosphere) and FilmArray® (BioFire®) molecular assays for identification of causative organisms in bacterial bloodstream infections. Eur J Clin Microbiol Infect Dis 2015;34:487–496 [CrossRef][PubMed]
    [Google Scholar]
  12. Kolman S, Arielly H, Paitan Y. Evaluation of single and double-locus real-time PCR assays for methicillin-resistant Staphylococcus aureus (MRSA) surveillance. BMC Res Notes 2010;3:110 [CrossRef][PubMed]
    [Google Scholar]
  13. McCoy MH, Relich RF, Davis TE, Schmitt BH. Performance of the FilmArray® blood culture identification panel utilized by non-expert staff compared with conventional microbial identification and antimicrobial resistance gene detection from positive blood cultures. J Med Microbiol 2016;65:619–625 [CrossRef][PubMed]
    [Google Scholar]
  14. Pardo J, Klinker KP, Borgert SJ, Butler BM, Giglio PG et al. Clinical and economic impact of antimicrobial stewardship interventions with the FilmArray blood culture identification panel. Diagn Microbiol Infect Dis 2016;84:159–164 [CrossRef][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000714
Loading
/content/journal/jmm/10.1099/jmm.0.000714
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error