title: Use of PNA FISH for blood cultures growing Gram-positive cocci in chains without a concomitant antibiotic stewardship intervention does not improve time to appropriate antibiotic therapy.
abstract: Peptide nucleic acid fluorescence in situ hybridization (PNA FISH) is a rapid diagnostic assay that can identify certain organisms growing in blood cultures 30-90 min from the time of positive Gram-stain. Existing studies have demonstrated a clinical utility with this assay when antibiotic stewardship programs assist clinicians with interpreting the results. However, the benefit of these rapid assays in the absence of concomitant antibiotic stewardship involvement is unclear. In this randomized study of 220 patients with enterococcal or streptococcal bacteremia, we found that PNA FISH, in the absence of concomitant input from an antibiotic stewardship program, had no impact on time to effective or optimal therapy, length of hospital stay, or in-hospital mortality. Our results suggest that in the absence of guidance from an antibiotic stewardship program, the clinical benefits of rapid diagnostic microbiological tools may be reduced.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: scosgro1@jhmi.edu.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Cosgrove
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: David X
authors.initials: DX
authors.lastname: Li
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Pranita D
authors.initials: PD
authors.lastname: Tamma
authors.affiliation: Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Edina
authors.initials: E
authors.lastname: Avdic
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Eric
authors.initials: E
authors.lastname: Hadhazy
authors.affiliation: Department of Pathology, Division of Medical Microbiology, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Teresa
authors.initials: T
authors.lastname: Wakefield
authors.affiliation: Department of Pathology, Division of Medical Microbiology, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Michael
authors.initials: M
authors.lastname: Gherna
authors.affiliation: Department of Pathology, Division of Medical Microbiology, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Carroll
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D000071997:Blood Culture; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D006095:Gram-Positive Cocci / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D020135:Peptide Nucleic Acids; D011897:Random Allocation; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D020135:Peptide Nucleic Acids
keywords: Antibiotic stewardship; Bacteremia; PNA FISH; Rapid diagnostics