Abstract
Inadequate therapy in bloodstream infections is suggested to be associated with higher mortality. We evaluated the reduction in inappropriate antibiotic therapy using rapid identification and antibiotic susceptibility testing (FAST) compared to standard of care (SOC) testing in patients with bloodstream infections. The FAST method used polymerase chain reaction (PCR) for identification and to detect growth in the presence or absence of antibiotics after only 6 h. For SOC testing, the BD Phoenix system was used. Patients with blood cultures growing Staphylococcus, Streptococcus or Enterococcus species or Gram-negative rods were randomised for FAST or SOC tests. A total of 129 patients were randomised for FAST and 121 patients for the SOC group. At the time SOC results became available, 78 patients in the FAST group could have been switched to more appropriate therapy. Although FAST results were highly accurate (agreement with SOC was 94 %), they were only implemented in a minority (16) of patients. However, significantly fewer patients in the FAST group used inappropriate therapy at the time of SOC results (p = 0.025). The time to results in the FAST group was reduced by 15.6 h (p < 0.001). In the patients switched after FAST, this was done after a mean of 42.3 h compared to 61.4 h in those switched after SOC tests (p < 0.001). In bacteraemic patients, FAST resulted in significantly more patients using appropriate antibiotic therapy at the time SOC results were available and 15.6 h earlier than SOC tests. However, the implementation of FAST results was not optimal and no benefit on clinical outcome was shown.
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Acknowledgements
The authors would like to thank Su Yan Yue, Rick Thissen, Gertjan Wagenvoort and Charlotte Hakkers for their assistance in the patient inclusion, data collection and laboratory work. This work was supported by the Profileringsfonds azM (grant number PF245). Parts of these results were presented at IDWeek 2012 in San Diego, CA, USA, October 2012.
Ethical standards
The study was approved by the MUMC Medical Ethics Committee. Patients were included after written informed consent was obtained.
Conflict of interest
All authors have contributed significantly to the study. No conflicts of interest were reported by any of the authors. The Profileringsfonds azM had no role in the study design, in the collection or analysis of data, or in the writing or submission of the manuscript.
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Beuving, J., Wolffs, P.F.G., Hansen, W.L.J. et al. Impact of same-day antibiotic susceptibility testing on time to appropriate antibiotic treatment of patients with bacteraemia: a randomised controlled trial. Eur J Clin Microbiol Infect Dis 34, 831–838 (2015). https://doi.org/10.1007/s10096-014-2299-0
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DOI: https://doi.org/10.1007/s10096-014-2299-0