title: Rapid testing using the Verigene Gram-negative blood culture nucleic acid test in combination with antimicrobial stewardship intervention against Gram-negative bacteremia.
abstract: Rapid identification of microorganisms and antimicrobial resistance is paramount for targeted treatment in serious bloodstream infections (BSI). The Verigene Gram-negative blood culture nucleic acid test (BC-GN) is a multiplex, automated molecular diagnostic test for identification of eight Gram-negative (GN) organisms and resistance markers from blood culture with a turnaround time of approximately 2 h. Clinical isolates from adult patients at the University Maryland Medical Center with GN bacteremia from 1 January 2012 to 30 June 2012 were included in this study. Blood culture bottles were spiked with clinical isolates, allowed to incubate, and processed by BC-GN. A diagnostic evaluation was performed. In addition, a theoretical evaluation of time to effective and optimal antibiotic was performed, comparing actual antibiotic administration times from chart review ("control") to theoretical administration times based on BC-GN reporting and antimicrobial stewardship team (AST) review ("intervention"). For organisms detected by the assay, BC-GN correctly identified 95.6% (131/137), with a sensitivity of 97.1% (95% confidence interval [CI], 90.7 to 98.4%) and a specificity of 99.5% (95% CI, 98.8 to 99.8%). CTX-M and OXA resistance determinants were both detected. Allowing 12 h from Gram stain for antibiotic implementation, the intervention group had a significantly shorter duration to both effective (3.3 versus 7.0 h; P < 0.01) and optimal (23.5 versus 41.8 h; P < 0.01) antibiotic therapy. BC-GN with AST intervention can potentially decrease time to both effective and optimal antibiotic therapy in GN BSI.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA jbork@ihv.umaryland.edu.
authors.forename: Jacqueline T
authors.initials: JT
authors.lastname: Bork
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA Department of Public Health and Epidemiology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Surbhi
authors.initials: S
authors.lastname: Leekha
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Heil
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: LiCheng
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA Department of Public Health and Epidemiology, University of Maryland School of Medicine, Baltimore, Maryland, USA Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland, USA Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Rilwan
authors.initials: R
authors.lastname: Badamas
authors.affiliation: Department of Public Health and Epidemiology, University of Maryland School of Medicine, Baltimore, Maryland, USA Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: J Kristie
authors.initials: JK
authors.lastname: Johnson
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D024881:Drug Resistance, Bacterial / Q000235:genetics; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000235:genetics*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D009696:Nucleic Acids / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D009696:Nucleic Acids