Background

Timely availability of microbiological results from positive blood cultures is essential to enable early pathogen-directed therapy. The Accelerate Pheno system (ADX) is a novel technology using fluorescence in situ hybridization for rapid species identification (ID) and morphokinetic bacterial analysis for phenotypic antimicrobial susceptibility testing (AST), with promising results. Yet the impact of this technology on clinical management and patient outcome remains unclear.

Methods

We conducted a quasiexperimental before-and-after observational study and analyzed 3 groups with different diagnostic and therapeutic pathways following recent integration of ADX: conventional microbiological diagnostics with and without antimicrobial stewardship program (ASP) intervention, and rapid diagnostics (ADX in addition to conventional standard) with ASP intervention. Primary endpoints were time to adequate, to optimal and to step-down antimicrobial therapy. Secondary endpoints were antimicrobial consumption, in-hospital mortality, length of stay (LOS), and the incidence of Clostridioidesdifficile infection (CDI).

Results

Two hundred four patients (conventional diagnostics, n = 64; conventional diagnostics + ASP, n = 68; rapid diagnostics + ASP; n = 72) were evaluated. The use of ADX significantly decreased time from Gram stain to ID (median, 23 vs 2.2 hours, P < .001) and AST (median, 23 vs 7.4 hours, P < .001), from Gram stain to optimal therapy (median, 11 vs 7 hours, P = .024) and to step-down antimicrobial therapy (median, 27.8 vs 12 hours, P = .019). However, groups did not differ in antimicrobial consumption, duration of antimicrobial therapy, mortality, LOS, or incidence of CDI.

Conclusions

Use of ADX significantly reduced time to ID and AST as well as time to optimal antimicrobial therapy but did not affect antimicrobial consumption and clinical outcome.

中文翻译：

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通过同日表型抗菌药敏试验从阳性血培养中快速鉴定物种对血流感染的管理和结果的临床影响

背景

及时获得来自阳性血培养的微生物结果对于实现早期病原体导向治疗至关重要。Accelerate Pheno 系统 (ADX) 是一种新技术，它使用荧光原位杂交进行快速物种鉴定 (ID) 和形态动力学细菌分析以进行表型抗菌药物敏感性测试 (AST)，并取得了可喜的成果。然而，这项技术对临床管理和患者结果的影响仍不清楚。

方法

我们进行了一项准实验前后观察性研究，并分析了最近整合 ADX 后具有不同诊断和治疗途径的 3 组：有和没有抗菌药物管理计划 (ASP) 干预的常规微生物诊断和快速诊断 (ADX 除了常规标准）与 ASP 干预。主要终点是充分、最佳和逐步减少抗菌治疗的时间。次要终点是抗生素使用量、住院死亡率、住院时间 (LOS) 和艰难梭菌感染 (CDI) 的发生率。

结果

对 204 名患者（常规诊断，n = 64；常规诊断 + ASP，n = 68；快速诊断 + ASP；n = 72）进行了评估。从革兰染色到最佳治疗（中位数， 11 与 7 小时，P = .024）和逐步减少抗菌治疗（中位数，27.8 与 12 小时，P = .019）。然而，各组在抗菌药物使用量、抗菌药物治疗持续时间、死亡率、LOS 或 CDI 发生率方面没有差异。

结论

ADX 的使用显着缩短了达到 ID 和 AST 的时间以及达到最佳抗菌治疗的时间，但不影响抗菌药物的消耗和临床结果。