The impact of implementation of rapid blood culture identification panels on antimicrobial optimization: a retrospective cohort study

Tyler Martin; Eli Wilber; Shreena Advani; Joseph Torrisi; Manish Patel; Paulina A Rebolledo; Yun F Wang; Sheetal Kandiah

doi:10.1017/ash.2024.51

The impact of implementation of rapid blood culture identification panels on antimicrobial optimization: a retrospective cohort study

Antimicrob Steward Healthc Epidemiol. 2024 Apr 16;4(1):e44. doi: 10.1017/ash.2024.51. eCollection 2024.

Authors

Tyler Martin¹, Eli Wilber², Shreena Advani¹, Joseph Torrisi¹, Manish Patel¹, Paulina A Rebolledo^{2

3

4}, Yun F Wang^{5

6}, Sheetal Kandiah^{2

4}

Affiliations

¹ Department of Pharmacy, Grady Health System, Atlanta, GA, USA.
² Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
³ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁴ Grady Healthcare System, Atlanta, GA, USA.
⁵ Clinical Microbiology Laboratory, Grady Health System, Atlanta, GA, USA.
⁶ Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.

Abstract

Objective: Determine the impact of limited implementation of a rapid blood culture identification (BCID) panel.

Design: Retrospective cohort study.

Methods: From February to April 2022, positive blood cultures identified via e-Plex BCID (Roche, Carlsbad, CA) were compared to those identified using standard microbial identification techniques. The primary outcomes assessed were time to optimal therapy, time to de-escalation of anti-MRSA (methicillin-resistant Staphylococcus aureus) agents, and time to de-escalation of anti-pseudomonal agents. Additional analysis investigated the impact of the availability of antimicrobial stewardship program support. This study was conducted at Grady Health System, a large metropolitan safety-net hospital in the southeastern United States.

Results: A total of 253 blood cultures were included in this study (153 BCID and 100 standard). Blood culture identification use was associated with a reduction in median time to optimal antimicrobial therapy (43.4 vs 72.1 h, P < .001) and median time to de-escalation of anti-MRSA agents (27.7 vs 46.7 h, P = .006), and a trend towards reduction of median time to de-escalation of anti-pseudomonal agents (38.8 vs 54.8 h, P = .07). These reductions persisted when controlling for patient age, sex, intensive care unit status, Charlson Comorbidity Index, and antimicrobial stewardship program availability.

Conclusions: Despite restricted use and lack of 24/7 antimicrobial stewardship program availability, BCID panel utilization was associated with earlier initiation of optimal therapy and pathogen identification with subsequent de-escalation of broad-spectrum antimicrobials, as compared to standard antimicrobial techniques. This suggests the potential for benefit from adopting novel diagnostic technologies outside of idealized fully-resourced settings.