title: Rapid Identification of Microorganisms by FilmArray Blood Culture Identification Panel Improves Clinical Management in Children.
abstract: BACKGROUND
  Blood cultures are a common investigation for children admitted to hospital. In routine practice, it takes at least 24 hours to identify an organism as a contaminant or clinically significant. FilmArray Blood Culture Identification Panel (FA-BCIP) is a multiplex polymerase chain reaction that can detect 24 pathogens within 1 hour. We assessed whether results from FA-BCIP lead to changes in clinical management in a tertiary referral paediatric hospital.
  
  
  METHODS
  We prospectively studied children having blood cultures taken at our tertiary children's hospital. Blood cultures were monitored and organisms identified using standard methods. FA-BCIP was performed when growth was initially detected in first positive blood cultures per episode, between January 1 and June 30, 2014. Assessment of whether the FA-BCIP result altered clinical management was made, specifically focused on antimicrobial stewardship and length of stay.
  
  
  RESULTS
  FA-BCIP was done on 117 positive blood cultures; 74 (63%) grew clinically significant organisms, 43 (37%) grew contaminants. FA-BCIP results were judged to alter clinical management in 63 of the 117 episodes (54%). Antimicrobials were started/altered in 23 (19%) episodes and de-escalated/withheld/stopped in 29 (25%) episodes. Ten children were discharged from hospital earlier, which saved a cumulative total of 14 bed days.
  
  
  CONCLUSIONS
  Rapid identification of microorganisms in pediatric blood cultures by FA-BCIP, led to changes in clinical management for half of the episodes. This improved antimicrobial stewardship and allowed early discharge from hospital for 10% of children. Future studies should focus on how best to use this technology in a cost-effective manner.
authors.affiliation: From the *Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom; †Department of Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom; ‡Department of Microbiology, Rotunda Hospital, Dublin, Ireland; §Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland; ¶Department of Microbiology, and ‖Department of Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Stephen T J
authors.initials: ST
authors.lastname: Ray
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Drew
authors.forename: Fiona
authors.initials: F
authors.lastname: Hardiman
authors.forename: Barry
authors.initials: B
authors.lastname: Pizer
authors.forename: Andrew
authors.initials: A
authors.lastname: Riordan
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001769:Blood / Q000382:microbiology*; D000071997:Blood Culture; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis*; D062606:Tertiary Care Centers; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents