title: Clinical impact of a real-time PCR assay for rapid identification of staphylococcal bacteremia.
abstract: The purpose of this study was to evaluate the impact of real-time PCR reporting both on timely identification of clustered Gram-positive cocci (GPC) in blood cultures and on appropriate antibiotic treatment. This retrospective, interventional cohort study evaluated inpatients with blood cultures positive for GPC in the pre-PCR (15 January 2009 to 14 January 2010) and post-PCR (15 January 2010 to 14 January 2011) periods. Post-PCR implementation, laboratory services completed batched PCR; results other than methicillin-resistant Staphylococcus aureus (MRSA) were reported in the electronic medical record without additional interventions. The assay's sensitivity and specificity, time to identification of staphylococcal bacteremia, and clinically relevant outcomes, including time to optimal antibiotic therapy, were evaluated. Demographic information was also collected and analyzed. Sixty-eight and 58 patients with Staphylococcus aureus bacteremia from the pre- and post-PCR periods, respectively, met inclusion criteria. Similar numbers of consecutive patients with coagulase-negative staphylococci were analyzed for comparison. The time to identification was significantly reduced post-PCR implementation (mean, 13.2 h; 95% confidence interval [95% CI], 10.5 to 15.9 h; P < 0.0001). However, the time to optimal antibiotic therapy was not significantly reduced. We conclude that implementation of a PCR assay demonstrated the potential to improve appropriate antibiotic use based on clinically meaningful and statistically significant reductions in the time to microbiologic identification. However, in order to realize this potential benefit, processes must be optimized and additional interventions initiated to facilitate providers' use of the PCR result.
authors.affiliation: Department of Pharmacy, Providence St. Vincent Medical Center, Portland, Oregon, USA. abigail.frye@providence.org
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Frye
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Baker
authors.forename: D Leif
authors.initials: DL
authors.lastname: Rustvold
authors.forename: Kim A
authors.initials: KA
authors.lastname: Heath
authors.forename: Jessica
authors.initials: J
authors.lastname: Hunt
authors.forename: James E
authors.initials: JE
authors.lastname: Leggett
authors.forename: Margret
authors.initials: M
authors.lastname: Oethinger
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D001431:Bacteriological Techniques / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
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