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Arch Pathol Lab Med. 2016 Mar;140(3):267-75. doi: 10.5858/arpa.2015-0119-OA.

Impact of a Rapid Blood Culture Assay for Gram-Positive Identification and Detection of Resistance Markers in a Pediatric Hospital.

Author information

1
From the Departments of Pediatrics, Division of Infectious Diseases (Drs Felsenstein and Bender).
2
Preventive Medicine (Dr Sposto).
3
Pharmacy (Drs Gentry and Takemoto), and Pathology and Laboratory Medicine (Dr Dien Bard).

Abstract

CONTEXT:

Molecular diagnostics allow for rapid identification and detection of resistance markers of bloodstream infection, with a potential for accelerated antimicrobial optimization and improved patient outcomes. Although the impact of rapid diagnosis has been reported, studies in pediatric patients are scarce.

OBJECTIVE:

To determine the impact of a molecular blood-culture assay that identifies a broad-spectrum of pathogens and resistance markers in pediatric patients with gram-positive bloodstream infections.

DESIGN:

Data on the time to antimicrobial optimization, the length of hospitalization, and the hospital cost following implementation of a rapid assay were prospectively collected and compared with corresponding preimplementation data.

RESULTS:

There were 440 episodes from 383 patients included, 221 preimplementation episodes and 219 postimplementation episodes. Overall time to antimicrobial optimization was shortened by 12.5 hours (P = .006), 11.9 hours (P = .005) for bloodstream infections of Staphylococcus aureus specifically. Duration of antibiotics for those with probable blood-culture contamination with coagulase-negative staphylococci was reduced by 36.9 hours (P < .001). Median length of stay for patients admitted to general pediatric units was 1.5 days shorter (P = .04), and median hospital cost was $3757 (P = .03) less after implementation. For S aureus bloodstream infections, median length of stay and hospital cost were decreased by 5.6 days (P = .01) and $13,341 (P = .03), respectively.

CONCLUSIONS:

Implementation of molecular assay for the detection of gram-positive pathogens and resistance markers significantly reduced time to identification and resistance detection, resulting in accelerated optimization of therapy, shorter length of stay, and decreased health care cost.

PMID:
26927722
DOI:
10.5858/arpa.2015-0119-OA
[Indexed for MEDLINE]

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