Rapid test linked to quicker optimal therapy for blood infections
Implementation of a test that provides rapid bacterial identification and susceptibility results from positive blood cultures shortened the time to optimal antibiotic therapy and reduced unnecessary antibiotic exposure in hospitalized patients with bacteremia, researchers reported late last week in the Journal of Antimicrobial Chemotherapy.
The Improving Outcomes and Antibiotic Stewardship for patients with gram-positive bloodstream infections (IOAS) study, led by scientists from Accelerate Diagnostics (which also provided funding), evaluated clinical and antimicrobial stewardship metrics at two hospitals in Arkansas and Iowa following implementation of the Accelerate PhenoTest BC Kit (AXDX), a diagnostic platform that can identify bacteria from blood cultures and provide antimicrobial susceptibility testing (AST) results up to 40 hours faster than conventional methods.
The researchers analyzed two groups of patients with gram-positive bacteremia, one that underwent traditional identification and AST (pre-AXDX) and one that underwent testing with AXDX (post-AXDX). The primary outcome was time to optimal therapy (TTOT), and secondary outcomes included time to first antibiotic modification (overall and gram-positive antibiotics) and duration on unnecessary coverage for methicillin-resistant Staphylococcus aureus (MRSA).
A total of 219 patients with gram-positive bacteremia (109 pre-AXDX and 110 post-AXDX) were included in the study. The median TTOT was 36.3 hours in the pre-AXDX group and 20.4 hours in the post-AXDX group. Analysis of secondary outcomes showed that the median time to first antibiotic modification was also reduced in the post-AXDX patients (15.9 hours vs 29.1 hours), as was the median time to first gram-positive antibiotic modification (17.2 hours vs 33.2 hours) and the median duration of unnecessary MRSA coverage (29.7 hours vs 58.4 hours).
The researchers also observed a trend toward decreased acute kidney injury in the post-AXDX group compared with the pre-AXDX group (13% vs 24%) but found no differences in clinical outcomes such as mortality, Clostridioides difficile infection (CDI), and readmission to the hospital.
"In summary, implementation of AXDX offered a comprehensive solution to replace various identification and phenotypic testing methods and had a meaningful impact on the management of patients with Gram-positive bacteraemia in the IOAS study," the study authors wrote. "TTOT and initial antibiotic modifications were significantly faster, and patients received less unnecessary antibiotic therapy compared with conventional microbiology diagnostics."
May 22 J Antimicrob Chemother study
WHO, Switzerland to launch first BioHub lab to share pathogen samples
In a step designed to speed pathogen risk assessment and countermeasure development, as well as to broaden access, the World Health Organization (WHO) and Switzerland today signed a memorandum of understanding to launch the first WHO BioHub facility, part of the WHO BioHub system first announced in November.
The biosafety lab in Spiez will safely receive, sequence, store, and prepare pathogen samples for sharing with other laboratories, the WHO said in a press release. It said the current system is slow and done bilaterally on an ad hoc basis, which leaves some countries without access to the resulting benefits and tools.
The WHO said BioHub sharing is done according to pre-agreed conditions that relate to biosecurity, biosafety, and other regulations, ensuring more timely and predictable response operations.
Also, the WHO said it will broaden the BioHub system to include qualified manufacturers and is currently running a pilot system with SARS-CoV-2 and its variants to test such sharing. Pending those results, BioHub will expand to other pathogens in 2022.
May 24 WHO press release