title: Impact of a Rapid Blood Culture Assay for Gram-Positive Identification and Detection of Resistance Markers in a Pediatric Hospital.
abstract: BACKGROUND
  Molecular diagnostics allow for rapid identification and detection of resistance markers of bloodstream infection, with a potential for accelerated antimicrobial optimization and improved patient outcomes. Although the impact of rapid diagnosis has been reported, studies in pediatric patients are scarce.
  
  
  OBJECTIVE
  To determine the impact of a molecular blood-culture assay that identifies a broad-spectrum of pathogens and resistance markers in pediatric patients with gram-positive bloodstream infections.
  
  
  METHODS
  Data on the time to antimicrobial optimization, the length of hospitalization, and the hospital cost following implementation of a rapid assay were prospectively collected and compared with corresponding preimplementation data.
  
  
  RESULTS
  There were 440 episodes from 383 patients included, 221 preimplementation episodes and 219 postimplementation episodes. Overall time to antimicrobial optimization was shortened by 12.5 hours (P = .006), 11.9 hours (P = .005) for bloodstream infections of Staphylococcus aureus specifically. Duration of antibiotics for those with probable blood-culture contamination with coagulase-negative staphylococci was reduced by 36.9 hours (P < .001). Median length of stay for patients admitted to general pediatric units was 1.5 days shorter (P = .04), and median hospital cost was $3757 (P = .03) less after implementation. For S aureus bloodstream infections, median length of stay and hospital cost were decreased by 5.6 days (P = .01) and $13,341 (P = .03), respectively.
  
  
  CONCLUSIONS
  Implementation of molecular assay for the detection of gram-positive pathogens and resistance markers significantly reduced time to identification and resistance detection, resulting in accelerated optimization of therapy, shorter length of stay, and decreased health care cost.
authors.affiliation: From the Departments of Pediatrics, Division of Infectious Diseases (Drs Felsenstein and Bender).
authors.forename: Susanna
authors.initials: S
authors.lastname: Felsenstein
authors.affiliation: Preventive Medicine (Dr Sposto).
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Bender
authors.affiliation: Pharmacy (Drs Gentry and Takemoto), and Pathology and Laboratory Medicine (Dr Dien Bard).
authors.forename: Richard
authors.initials: R
authors.lastname: Sposto
authors.forename: Matthew
authors.initials: M
authors.lastname: Gentry
authors.forename: Carol
authors.initials: C
authors.lastname: Takemoto
authors.forename: Jennifer Dien
authors.initials: JD
authors.lastname: Bard
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D001426:Bacterial Proteins / Q000032:analysis* / Q000235:genetics; D015415:Biomarkers / Q000378:metabolism; D001769:Blood / Q000382:microbiology; D002648:Child; D015331:Cohort Studies; D017046:Cost Savings; D003365:Costs and Cost Analysis; D004269:DNA, Bacterial / Q000032:analysis*; D024881:Drug Resistance, Bacterial; D006094:Gram-Positive Bacteria / Q000145:classification / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D017721:Hospital Costs; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007902:Length of Stay; D015141:Los Angeles; D058889:Molecular Typing / Q000191:economics; D011446:Prospective Studies; D061665:Time-to-Treatment
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015415:Biomarkers; D004269:DNA, Bacterial