1887

Abstract

bacteraemia (SAB) causes significant morbidity and mortality. Standard diagnostic methods require 24–48 h to provide results, during which time management is guideline-based and may be suboptimal.

Evaluate the impact of rapid molecular detection of in positive blood culture bottle fluid on patient management.

Samples were tested prospectively at two clinical centres. Positive blood cultures with Gram-positive cocci in clusters on microscopy were tested with the Xpert MRSA/SA blood culture assay (Cepheid), as well as standard culture-based identification and antimicrobial sensitivity tests. Results were passed to clinical microbiologists in real time and used for patient management.

Of 264 blood cultures tested (184 and 80 from each centre), was grown from 39 (14.8 %) with one identified as methicillin-resistant ; all Xpert results agreed with culture results. Median turnaround time from culture flagging positive to result reporting for Xpert was 1.7 h, compared to 25.7 h for species identification by culture. Xpert results allowed early changes to management in 40 (16.8 %) patients, with Xpert positive patients starting specific therapy for SAB and Xpert negative patients stopping or avoiding empiric antimicrobials for SAB.

Rapid and accurate detection of with the Xpert MRSA/SA BC assay in positive blood culture bottles allowed earlier targeted patient management. Negative Xpert results are suggestive of coagulase negative staphylococci, allowing de-escalation of antimicrobial therapy if clinically appropriate.

Funding
This study was supported by the:
  • This work was fund the Scottish Government HAI Policy Unit. (Award NA)
    • Principle Award Recipient: Fiona M MacKenzie
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2020-03-06
2024-03-29
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References

  1. Goto M, Al-Hasan MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect 2013; 19:501–509 [View Article][PubMed]
    [Google Scholar]
  2. Vrijens F, Hulstaert F, Van de Sande S, Devriese S, Morales I et al. Hospital-Acquired, laboratory-confirmed bloodstream infections: linking national surveillance data to clinical and financial hospital data to estimate increased length of stay and healthcare costs. J Hosp Infect 2010; 75:158–162 [View Article][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 [View Article][PubMed]
    [Google Scholar]
  4. Ferrer R, Martin-Loeches I, Phillips G, Osborn TM, Townsend S et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med 2014; 42:1749–1755 [View Article][PubMed]
    [Google Scholar]
  5. Kerremans JJ, Verboom P, Stijnen T, Hakkaart-van Roijen L, Goessens W et al. Rapid identification and antimicrobial susceptibility testing reduce antibiotic use and accelerate pathogen-directed antibiotic use. J Antimicrob Chemother 2008; 61:428–435 [View Article][PubMed]
    [Google Scholar]
  6. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348:1546–1554 [View Article][PubMed]
    [Google Scholar]
  7. Opota O, Croxatto A, Prod'hom G, Greub G. Blood culture-based diagnosis of bacteraemia: state of the art. Clin Microbiol Infect 2015; 21:313–322 [View Article][PubMed]
    [Google Scholar]
  8. Diekema DJ, Beekmann SE, Chapin KC, Morel KA, Munson E et al. Epidemiology and outcome of nosocomial and community-onset bloodstream infection. J Clin Microbiol 2003; 41:3655–3660 [View Article][PubMed]
    [Google Scholar]
  9. Wong D, Wong T, Romney M, Leung V. Comparative effectiveness of β-lactam versus vancomycin empiric therapy in patients with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Ann Clin Microbiol Antimicrob 2016; 15:1–9 [View Article]
    [Google Scholar]
  10. Kim S-H, Kim K-H, Kim H-B, Kim N-J, Kim E-C et al. Outcome of vancomycin treatment in patients with methicillin-susceptible Staphylococcus aureus bacteremia. Antimicrob Agents Chemother 2008; 52:192–197 [View Article][PubMed]
    [Google Scholar]
  11. Beekmann SE, Diekema DJ, Doern GV. Determining the clinical significance of coagulase-negative staphylococci isolated from blood cultures. Infect Control Hosp Epidemiol 2005; 26:559–566 [View Article][PubMed]
    [Google Scholar]
  12. Bauer KA, Perez KK, Forrest GN, Goff DA. Review of rapid diagnostic tests used by antimicrobial stewardship programs. Clin Infect Dis 2014; 59 Suppl 3:S134–S145 [View Article][PubMed]
    [Google Scholar]
  13. Wolk DM, Struelens MJ, Pancholi P, Davis T, Della-Latta P et al. Rapid detection of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) in wound specimens and blood cultures: multicenter preclinical evaluation of the Cepheid Xpert MRSA/SA skin and soft tissue and blood culture assays. J Clin Microbiol 2009; 47:823–826 [View Article][PubMed]
    [Google Scholar]
  14. Noto MJ, Kreiswirth BN, Monk AB, Archer GL. Gene acquisition at the insertion site for SCCmec, the genomic island conferring methicillin resistance in Staphylococcus aureus . J Bacteriol 2008; 190:1276–1283 [View Article][PubMed]
    [Google Scholar]
  15. Bauer KA, West JE, Balada-Llasat J-M, Pancholi P, Stevenson KB et al. An antimicrobial stewardship program's impact with rapid polymerase chain reaction methicillin-resistant Staphylococcus aureus/S. aureus blood culture test in patients with S. aureus bacteremia. Clin Infect Dis 2010; 51:1074–1080 [View Article][PubMed]
    [Google Scholar]
  16. Parta M, Goebel M, Thomas J, Matloobi M, Stager C et al. Impact of an assay that enables rapid determination of Staphylococcus species and their drug susceptibility on the treatment of patients with positive blood culture results. Infect Control Hosp Epidemiol 2010; 31:1043–1048 [View Article][PubMed]
    [Google Scholar]
  17. Ratnayake L, Olver WJ. Rapid PCR detection of methicillin-resistant Staphylococcus aureus and methicillin-sensitive S. aureus samples from charcoal-containing blood culture bottles. J Clin Microbiol 2011; 49:2382 [View Article][PubMed]
    [Google Scholar]
  18. Scottish Antimicrobial Prescribing Group 2017; Staph aureus Bacteraemia Quality Improvement. SAPG - Scottish Antimicrobial Prescribing Group . https://www.sapg.scot/quality-improvement/hospital-prescribing/staph-aureus-bacteraemia 20 Feb 2019
  19. Parta M, Goebel M, Matloobi M, Stager C, Musher DM. Identification of methicillin-resistant or methicillin-susceptible Staphylococcus aureus in blood cultures and wound swabs by GeneXpert. J Clin Microbiol 2009; 47:1609–1610 [View Article][PubMed]
    [Google Scholar]
  20. Kelley PG, Grabsch EA, Farrell J, Xie S, Montgomery J et al. Evaluation of the Xpert MRSA/SA blood culture assay for the detection of Staphylococcus aureus including strains with reduced vancomycin susceptibility from blood culture specimens. Diagn Microbiol Infect Dis 2011; 70:404–407 [View Article][PubMed]
    [Google Scholar]
  21. Spencer DH, Sellenriek P, Burnham C-AD. Validation and implementation of the GeneXpert MRSA/SA blood culture assay in a pediatric setting. Am J Clin Pathol 2011; 136:690–694 [View Article][PubMed]
    [Google Scholar]
  22. Buchan BW, Allen S, Burnham C-AD, McElvania TeKippe E, Davis T et al. Comparison of the next-generation Xpert MRSA/SA bc assay and the GeneOhm StaphSR assay to routine culture for identification of Staphylococcus aureus and methicillin-resistant S. aureus in positive-blood-culture broths. J Clin Microbiol 2015; 53:804–809 [View Article][PubMed]
    [Google Scholar]
  23. Brown J, Paladino JA. Impact of rapid methicillin-resistant Staphylococcus aureus polymerase chain reaction testing on mortality and cost effectiveness in hospitalized patients with bacteraemia: a decision model. Pharmacoeconomics 2010; 28:567–575 [View Article][PubMed]
    [Google Scholar]
  24. Scanvic A, Courdavault L, Sollet J-P, Le Turdu F. [Interest of real-time PCR Xpert MRSA/SA on GeneXpert(®) DX System in the investigation of staphylococcal bacteremia]. Pathol Biol 2011; 59:67–72 [View Article][PubMed]
    [Google Scholar]
  25. Davies J, Gordon CL, Tong SYC, Baird RW, Davis JS. Impact of results of a rapid Staphylococcus aureus diagnostic test on prescribing of antibiotics for patients with clustered gram-positive cocci in blood cultures. J Clin Microbiol 2012; 50:2056–2058 [View Article][PubMed]
    [Google Scholar]
  26. Biendo M, Mammeri H, Pluquet E, Guillon H, Rousseau F et al. Value of Xpert MRSA/SA blood culture assay on the Gene Xpert Dx System for rapid detection of Staphylococcus aureus and coagulase-negative staphylococci in patients with staphylococcal bacteremia. Diagn Microbiol Infect Dis 2013; 75:139–143 [View Article][PubMed]
    [Google Scholar]
  27. Clerc O, Prod'hom G, Senn L, Jaton K, Zanetti G et al. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry and PCR-based rapid diagnosis of Staphylococcus aureus bacteraemia. Clin Microbiol Infect 2014; 20:355–360 [View Article][PubMed]
    [Google Scholar]
  28. Bhowmick T, Kirn TJ, Hetherington F, Takavarasha S, Sandhu SS et al. Collaboration between an antimicrobial stewardship team and the microbiology laboratory can shorten time to directed antibiotic therapy for methicillin-susceptible staphylococcal bacteremia and to discontinuation of antibiotics for coagulase-negative staphylococcal contaminants. Diagn Microbiol Infect Dis 2018; 92:214–219 [View Article][PubMed]
    [Google Scholar]
  29. European Centre for Disease Prevention and Control Surveillance of Antimicrobial Resistance in Europe - Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net) 2017 Stockholm: ECDC; 2018
    [Google Scholar]
  30. Peker N, Couto N, Sinha B, Rossen JW. Diagnosis of bloodstream infections from positive blood cultures and directly from blood samples: recent developments in molecular approaches. Clin Microbiol Infect 2018; 24:944–955 [View Article][PubMed]
    [Google Scholar]
  31. Ramanan P, Bryson AL, Binnicker MJ, Pritt BS, Patel R. Syndromic panel-based testing in clinical microbiology. Clin Microbiol Rev 2018; 31:e00024–17 [View Article][PubMed]
    [Google Scholar]
  32. Opota O, Jaton K, Greub G. Microbial diagnosis of bloodstream infection: towards molecular diagnosis directly from blood. Clin Microbiol Infect 2015; 21:323–331 [View Article][PubMed]
    [Google Scholar]
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