title: Real-world performance of a microarray-based rapid diagnostic for Gram-positive bloodstream infections and potential utility for antimicrobial stewardship.
abstract: The Verigene Gram-positive blood culture assay (BC-GP) is a microarray-based rapid diagnostic test, which includes targets for 12 bacterial species and 3 resistance determinants. We prospectively compared the diagnostic accuracy of the BC-GP to routine microbiologic methods and evaluated the potential of the BC-GP for antimicrobial stewardship programs. A total of 143 consecutive patients with Gram-positive bacteremia were included in the analysis. BC-GP correctly identified 127/128 (99.2%) of organisms from monomicrobial blood cultures and 9/14 (64.3%) from polymicrobial, including all methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. Stewardship interventions were possible in 51.0% of patients, most commonly stopping or preventing unnecessary vancomycin or starting a targeted therapy. In Monte Carlo simulations, unnecessary antibiotics could be stopped at least 24 hours earlier in 65.6% of cases, and targeted therapy could be started at least 24 hours earlier in 81.2%. BC-GP is a potentially useful test for antibiotic stewardship in patients with Gram-positive bacteremia.
authors.affiliation: Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, 1441 Moursund St, Houston, TX 77030. Electronic address: slaitken@uh.edu.
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Aitken
authors.affiliation: Division of Infectious Diseases, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030. Electronic address: vagish.hemmige@bcm.edu.
authors.forename: Vagish S
authors.initials: VS
authors.lastname: Hemmige
authors.affiliation: Division of Infectious Diseases, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030. Electronic address: koo@bcm.edu.
authors.forename: Hoonmo L
authors.initials: HL
authors.lastname: Koo
authors.affiliation: Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, 1441 Moursund St, Houston, TX 77030. Electronic address: nnvuong@uh.edu.
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Vuong
authors.affiliation: Department of Pathology, Baylor St. Luke's Medical Center, 6720 Bertner Ave, Houston, TX 77030. Electronic address: tlasco@stlukeshealth.org.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Lasco
authors.affiliation: Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, 1441 Moursund St, Houston, TX 77030. Electronic address: kgarey@uh.edu.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Garey
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D001769:Blood / Q000382:microbiology; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000187:drug effects / Q000235:genetics; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000235:genetics* / Q000472:pathogenicity; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics; D025202:Molecular Diagnostic Techniques / Q000379:methods / Q000706:statistics & numerical data; D009010:Monte Carlo Method; D054118:Nanospheres; D020411:Oligonucleotide Array Sequence Analysis / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D014640:Vancomycin / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Bacteremia; Enterococcus; Prospective cohort; Staphylococcus; Staphylococcus aureus; Streptococcus