The Effect of Molecular Rapid Diagnostic Testing on Clinical Outcomes in Bloodstream Infections: A Systematic Review and Meta-analysis.
BACKGROUND
Previous reports on molecular rapid diagnostic testing (mRDT) do not consistently demonstrate improved clinical outcomes in bloodstream infections (BSIs). This meta-analysis seeks to evaluate the impact of mRDT in improving clinical outcomes in BSIs.


METHODS
We searched PubMed, CINAHL, Web of Science, and EMBASE through May 2016 for BSI studies comparing clinical outcomes between mRDT and conventional microbiology methods.


RESULTS
Thirty-one studies were included with 5920 patients. The mortality risk was significantly lower with mRDT than with conventional microbiology methods (odds ratio [OR], 0.66; 95% confidence interval [CI], .54-.80), yielding a number needed to treat of 20. The mortality risk was slightly lower with mRDT in studies with antimicrobial stewardship programs (ASPs) (OR, 0.64; 95% CI, .51-.79), and non-ASP studies failed to demonstrate a significant decrease in mortality risk (0.72; .46-1.12). Significant decreases in mortality risk were observed with both gram-positive (OR, 0.73; 95% CI, .55-.97) and gram-negative organisms (0.51; .33-.78) but not yeast (0.90; .49-1.67). Time to effective therapy decreased by a weighted mean difference of -5.03 hours (95% CI, -8.60 to -1.45 hours), and length of stay decreased by -2.48 days (-3.90 to -1.06 days).


CONCLUSIONS
For BSIs, mRDT was associated with significant decreases in mortality risk in the presence of a ASP, but not in its absence. mRDT also decreased the time to effective therapy and the length of stay. mRDT should be considered as part of the standard of care in patients with BSIs.
Rhode Island Infectious Diseases Research Program, Providence Veterans Affairs Medical Center.|College of Pharmacy, University of Rhode Island, Kingston.
Tristan T
TT
Timbrook
Rhode Island Infectious Diseases Research Program, Providence Veterans Affairs Medical Center.|College of Pharmacy, University of Rhode Island, Kingston.
Jacob B
JB
Morton
Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center.
Kevin W
KW
McConeghy
Rhode Island Infectious Diseases Research Program, Providence Veterans Affairs Medical Center.|Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center.|College of Pharmacy, University of Rhode Island, Kingston.
Aisling R
AR
Caffrey
Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence.
Eleftherios
E
Mylonakis
Rhode Island Infectious Diseases Research Program, Providence Veterans Affairs Medical Center.|Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center.|College of Pharmacy, University of Rhode Island, Kingston.
Kerry L
KL
LaPlante
D000890:Anti-Infective Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D016469:Fungemia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D025202:Molecular Diagnostic Techniques / Q000379:methods; D009026:Mortality; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care
D000890:Anti-Infective Agents
antimicrobial stewardship; bloodstream infections; meta-analysis; rapid diagnostic tests