Impact of rapid identification of positive blood cultures using the Verigene system on antibiotic prescriptions: A prospective study of community-onset bacteremia in a tertiary hospital in Japan

PLoS One. 2017 Jul 24;12(7):e0181548. doi: 10.1371/journal.pone.0181548. eCollection 2017.

Abstract

Background: Rapid identification of positive blood cultures is important for initiation of optimal treatment in septic patients. Effects of automated, microarray-based rapid identification systems on antibiotic prescription against community-onset bacteremia (COB) remain unclear.

Methods: We prospectively enrolled 177 patients with 185 COB episodes (occurring within 72 h of admission) over 17 months. Bacteremia episodes due to gram-positive bacteria (GP) and gram-negative bacteria (GN) in the same patient were counted separately. For GP bacteremia, patients with ≥2 sets of positive blood cultures were included. The primary study objective was evaluating the rates of antibiotic prescription changes within 2 days of rapid identification using the Verigene system.

Results: Bacteremia due to GN and GP included 144/185 (77.8%) and 41/185 (22.2%) episodes, respectively. Antibiotic prescription changes occurred in 51/185 cases (27.6% [95%CI:21.3-34.6%]) after Verigene analysis and 70/185 cases (37.8% [30.8-45.2%]) after conventional identification and susceptibility testing. Prescription changes after Verigene identification were more frequent in GP (17/41[41.5%]) than in GN (34/144[23.5%]). Among bacteremia due to single pathogen targeted by Verigene test, bacterial identification agreement between the two tests was high (GP: 38/39[97.4%], GN: 116/116[100%]). The Verigene test correctly predicted targeted antimicrobial resistance. The durations between the initiation of incubation and reporting of the results for the Verigene system and conventional test was 28.3 h (IQR: 25.8-43.4 h) and 90.6 h (68.3-118.4 h), respectively. In only four of the seven episodes of COB in which two isolates were identified by conventional tests, the Verigene test correctly identified both organisms.

Conclusion: We observed a high rate of antibiotic prescription changes after the Verigene test in a population with COB especially in GP. The Verigene test would be a useful tool in antimicrobial stewardship programs among patients with COB.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Bacteremia / blood*
  • Bacteremia / drug therapy*
  • Bacteremia / epidemiology
  • Blood Culture / economics
  • Blood Culture / methods*
  • Female
  • Gram-Negative Bacteria / drug effects
  • Gram-Negative Bacteria / isolation & purification*
  • Gram-Positive Bacteria / drug effects
  • Gram-Positive Bacteria / isolation & purification*
  • Humans
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Prescriptions
  • Prospective Studies
  • Tertiary Care Centers

Substances

  • Anti-Bacterial Agents

Grants and funding

This study is supported in part by Hitachi High-Technologies Corporation & Grants for International Health Research (28S-1106) from the MHLW of Japan. Luminex Corporation manufactures/markets the Verigene® System (Verigene® Reader & Verigene® Processor), Verigene® Gram-Positive Blood Culture Nucleic Acid Test (BC-GP), and Verigene® Gram-Negative Blood Culture Nucleic Acid Test (BC-GN). Hitachi High-Technologies Corporation is a Marketing Authorization Holder of Verigene® System, Verigene® BC-GP, and Verigene® BC-GN in Japan. Verigene® BC-GP and Verigene® BC-GN used in the current study were provided by Hitachi High-Technologies Corporation. The authors were responsible for the cost of Verigene® System used in this study. Hitachi High-Technologies Corporation or Luminex Corporation had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.