scholarly journals 1024. Using DOOR-MAT to Theoretically Compare Three Rapid Diagnostic Tests for Gram-Negative Bloodstream Infections in Immunocompromised Patients

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S603-S604
Author(s):  
Lauren Groft ◽  
Mandee Noval ◽  
James Mease ◽  
J Kristie Johnson ◽  
Kimberly C Claeys
Keyword(s):  
Diagnostic Tests ◽  
Bloodstream Infections ◽  
Rapid Diagnostic Tests ◽  
Antibiotic Prescribing ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
Gram Negative ◽  
Significant Difference ◽  
The Mean ◽  
Organism Identification

Abstract Background Molecular rapid diagnostic tests (RDTs) for bloodstream infections (BSI) utilize a variety of technologies and differ substantially in organisms and resistance mechanisms detected. RDT platforms decrease time to optimal antibiotics; however, data on RDTs in special populations, such as immunocompromised are extremely limited. This study aimed to compare theoretical changes in antibiotics based on differences in panel identification of organisms and resistance targets among three commercially available RDT panels. Methods Retrospective cohort of immunocompromised patients treated for gram-negative BSI at University of Maryland Medical Center from January 2018 to September 2020. Immunocompromised was defined as active hematologic or solid tumor malignancy at time of BSI diagnosis, history of hematopoietic stem cell transplantation (HSCT) or solid organ transplantation (SOT), or absolute neutrophil count (ANC) < 1000 cells/mm3 at any time 30 days prior to BSI diagnosis. Verigene BC-GN was performed as standard of care. GenMark ePlex BCID and BioFire FilmArray BCID 2 results were assigned based on respective identifiable organism panels. An infectious diseases clinician blinded to final antimicrobial susceptibility testing (AST) results used RDT results to assign antibiotic treatments for each platform. Decisions were referenced against a priori DOOR-MAT matrices. A partial credit scoring system (0 to 100) was applied to each decision based on final AST results. The mean and standard deviation (SD) were compared across panels using One-Way Repeated Measures ANOVA with modified Bonferroni for multiple comparisons. Results A total of 146 patients met inclusion. Baseline characteristics are summarized in Table 1. The mean (SD) DOOR-MAT scores for the three RDT panels were: 86.1 (24.4) Verigene BC-GN vs. 88.5 (22.2) GenMark BCID vs. 87.2 (24.4) BioFire BCID 2. There was no statistically significant difference between the panels for DOOR-MAT score (P=0.6). Table 1. Baseline Patient Characteristics and Organism Identification Conclusion Within an immunocompromised patient population, differences in organism identification between three commercially available RDT panels did not impact theoretical antibiotic prescribing. Disclosures J. Kristie Johnson, PhD, D(ABMM), GenMark (Speaker’s Bureau) Kimberly C. Claeys, PharmD, GenMark (Speaker’s Bureau)

scholarly journals Effect of Differences in MIC Values on Clinical Outcomes in Patients with Bloodstream Infections Caused by Gram-Negative Organisms Treated with Levofloxacin

2008 ◽  
Vol 53 (3) ◽  
pp. 1074-1079 ◽  
Author(s):  
Robyn DeFife ◽  
Marc H. Scheetz ◽  
Joe M. Feinglass ◽  
Michael J. Postelnick ◽  
Kimberly K. Scarsi
Keyword(s):  
Length Of Stay ◽  
Bloodstream Infections ◽  
In Vitro Susceptibility ◽  
Average Hospital ◽  
Gram Negative ◽  
Significant Difference ◽  
All Cause Mortality ◽  
The Mean ◽  
Gram Negative Organisms

ABSTRACT Emerging evidence suggests that current fluoroquinolone dosing strategies may be inadequate to treat bloodstream infections caused by organisms classified as sensitive. This study sought to determine if differences in MICs for levofloxacin-susceptible gram-negative organisms correlate with differences in patient outcomes. A retrospective cohort study evaluated patients treated with levofloxacin for bloodstream infections caused by susceptible gram-negative organisms. Patients infected with gram-negative organisms for which MICs indicated susceptibility were categorized into three groups: those with organisms for which MICs were low (≤0.25 mg/liter), intermediate (0.5 mg/liter), and high (1 or 2 mg/liter). Patients were evaluated for baseline similarity, all-cause mortality, and measurements of morbidity. A total of 404 patients with bloodstream infections caused by gram-negative organisms were identified. Of these patients, 312 were treated with levofloxacin and included in the analysis. No significant difference in all-cause mortality among the three groups was observed. The high-MIC group had a significantly longer average hospital stay postculture than the low- and intermediate-MIC groups (16.4 days versus 7.3 and 7.9 days; P < 0.01) and a significantly longer duration of infection (2.1 days versus 1.0 and 1.2 days; P < 0.001). Multivariate analysis adjusting for covariates revealed that a high MIC was associated with an increase of 5.67 days (95% confidence interval, 0.77 to 10.62 days; P = 0.02) in the mean length of stay postculture compared to the mean length of stay for the low-MIC group. Patients treated with levofloxacin for bloodstream infections caused by gram-negative organisms for which MICs were elevated, yet still in the susceptible category, had worse outcomes than similar patients infected with organisms for which MICs were lower. In vitro susceptibility classifications of fluoroquinolones for the treatment of bloodstream infections caused by gram-negative organisms require further study.

scholarly journals 62. Follow-Up Blood Culture Practices for Gram-Negative Bloodstream Infections in Immunocompromised Hosts at a Large Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S42-S42
Author(s):  
Lauren Groft ◽  
James Mease ◽  
Jacqueline Bork ◽  
Ciera L Bernhardi ◽  
J Kristie Johnson ◽  
...  
Keyword(s):  
Blood Culture ◽  
Medical Center ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
Gram Negative ◽  
Baseline Characteristics

Abstract Background Routine follow-up blood cultures (FUBC) are strongly recommended for Staphylococcus aureus and Candida spp. bloodstream infections (BSI), but the role of FUBC in Gram-negative (GN) BSI remains controversial. Factors that may result in persistent GN BSI include critical illness, endovascular infection, lack of source control, multidrug resistant organisms (MDRO), end-stage renal disease, or immunocompromised status. As such, FUBC in patients with any of these factors may be warranted to improve clinical outcomes, but the true balance of benefit versus harm remains unknown. Our objective was to evaluate the role of FUBC in immunocompromised patients with GN BSI. Methods This was a retrospective observational cohort of adult, immunocompromised patients treated for confirmed GN BSI between January 2019 and December 2020 at University of Maryland Medical Center. Immunocompromise was defined as active hematologic or solid tumor malignancy at time of BSI diagnosis, history of hematopoietic stem cell transplantation (HSCT) or solid organ transplantation (SOT), or absolute neutrophil count (ANC) &lt; 1000 cells/mm3 at any time 30 days prior to BSI diagnosis. FUBC were defined as blood cultures drawn between 24 hours and 7 days from index blood culture, within the same hospital encounter. Positive FUBC was defined as a FUBC with same pathogenic GN organism identified. Comparison of patient and microbiologic characteristics was made between patients with and without FUBC. Results A total of 146 patients with GN BSI were included. Baseline characteristics are reported in Table 1. FUBC were collected in 129 (88.4%) patients. Neutropenia (49.6% vs. 19.4%, P=0.122), presence of central line (69.8% vs. 30.2%, P=0.061), and hospital-acquired origin of BSI (63.6% vs. 36.4%, P=0.395) resulted in increased frequency of FUBC. Patients with FUBC had a significantly longer post-BSI mean (SD) length of stay (17.3 [35.4] vs. 6.5 [6.0] days; P=0.005). Positive FUBC occurred in only 2 cases (1.4%) and both patients had persistent fevers at time of FUBC. Table 1. Baseline Characteristics Conclusion Positive FUBC were uncommon in this immunocompromised cohort with GN BSI, which challenges the need for routine collection of FUBC in this patient population. Disclosures Ciera L. Bernhardi, PharmD, Servier Pharmaceuticals (Advisor or Review Panel member) J. Kristie Johnson, PhD, D(ABMM), GenMark (Speaker’s Bureau) Kimberly C. Claeys, PharmD, GenMark (Speaker’s Bureau)

scholarly journals Difference of Procalcitonin Levels in Gram-Positive and Gram-Negative Bacterial Sepsis Patients of Indonesia Army Central Hospital Gatot Soebroto in 2016

2022 ◽  
Vol 13 (1) ◽  
pp. 38
Author(s):  
Nindy Handayani ◽  
Soroy Lardo ◽  
Nunuk Nugrohowati
Keyword(s):  
Mean Difference ◽  
P Value ◽  
Central Hospital ◽  
Bacterial Sepsis ◽  
Gram Positive ◽  
Cross Sectional ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Significant Difference ◽  
The Mean

Introduction: Procalcitonin is known as a marker of infection and indicator for severity of infections. In sepsis, elevated procalcitonin levels in blood have a significant value that can be used as a sepsis biomarker. The aim of this study was to determine the mean difference of procalcitonin levels in Gram-positive and Gram-negative bacterial sepsis patients.Methods: This study used quantitative method with cross sectional approach. The sample of this study were bacterial sepsis patients of Indonesia Army Central Hospital Gatot Soebroto in 2016 which were divided into two groups: Gram-positive and Gram-negative bacterial sepsis patients with the number of each group was 30 samples. The data were analyzed by using independent t test.Results: This study showed that mean levels of procalcitonin in Gram-positive bacterial sepsis patients was 6.47 ng/ml and Gram-negative was 66.04 ng/ml. There was a significant difference between mean levels of procalcitonin in Gram-positive and Gram-negative bacterial sepsis patients of Indonesia Army Central Hospital Gatot Soebroto in 2016 with p value = 0.000 (p < 0.05).Conclusion: The mean difference of procalcitonin levels in Gram-negative bacterial sepsis patients were higher than Gram-positive bacterial sepsis patients, because Gram-negative bacteria have lipopolysaccharide which is a strong immunostimulator and increases TNF-α production higher than Gram-positive bacteria. 

Implementation and optimization of molecular rapid diagnostic tests for bloodstream infections

2018 ◽  
Vol 75 (16) ◽  
pp. 1191-1202 ◽  
Author(s):  
Eric Wenzler ◽  
Tristan T. Timbrook ◽  
Jordan R. Wong ◽  
John M. Hurst ◽  
Shawn H. MacVane
Keyword(s):  
Diagnostic Tests ◽  
Bloodstream Infections ◽  
Rapid Diagnostic Tests

scholarly journals 2168. Comparison of Rapid Diagnostic Tests for Bloodstream Infections Using Desirability of Outcome Ranking Management of Antimicrobial Therapy (DOOR-MAT)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S735-S736
Author(s):  
Kimberly C Claeys ◽  
Teri Hopkins ◽  
Zegbeh Kpadeh-Rogers ◽  
Yunyun Jiang ◽  
Scott R Evans ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Antimicrobial Therapy ◽  
Diagnostic Tests ◽  
Scoring System ◽  
Medical Center ◽  
Credit Scoring ◽  
Bloodstream Infections ◽  
Rapid Diagnostic Tests ◽  
Average Score ◽  
Partial Credit

Abstract Background Rapid diagnostic tests (RDTs) for bloodstream infection (BSIs) are increasingly common. Decisions regarding which RDT to implement remains a clinical challenge given the diversity of organisms and resistance mechanisms detected by different platforms. The desirability of Outcome Ranking Management of Antimicrobial Therapy (DOOR-MAT) has been proposed as a framework to compare RDT platforms but reports of clinical application are lacking. This study compared potential antibiotic decisions based on results of two different RDTs for BSI using DOOR-MAT. Methods Retrospective study at University of Maryland Medical Center from August 2018 to April 2019 comparing Verigene® BC (VBC) to GenMark Dx ePlex® BCID for clinical blood cultures. VBC was part of standard of care, ePlex was run on discarded fresh or frozen blood samples. In this theoretical analysis, RDT result and local susceptibility data were applied by two Infectious Diseases pharmacists to make decisions regarding antibiotic selection in a blinded manner. Cohen’s Kappa statistic summarized overall agreement. DOOR-MAT, a partial credit scoring system, was applied to decisions based on final organism/susceptibility results (Figure 1). Scores were averaged between reviewers and mean scores compared between RDT systems using the t-test. Additionally, a sensitivity analysis with varied point assignment among Gram-negatives (AmpC-producers) was conducted. Results 110 clinical isolates were included; 41 Gram-negative, 69 Gram-positive organisms. Overall agreement was 82% for VBC and 83% for ePlex. The average score for VBC was 86.1 (SD 31.3) compared with ePlex 92.9 (SD 22.9), P = 0.004. Among Gram-negatives, the average score for VBC was 79.9 (SD 32.1) compared with ePlex 88.1 (SD 28.8), P = 0.032. Among GPs the average score for VBC was 89.9 (SD 30.4) compared with ePlex 95.8 (SD 18.3), P = 0.048. Sensitivity analysis demonstrated an average score for of 89.9 (SD 30.4) for VBC compared with 95.8 (SD 18.3) for ePlex, P = 0.27. Conclusion The use of a partial credit scoring system such as the DOOR-MAT allows for comparisons between RDT systems beyond sensitivity and specificity allowing for enhanced clinical interpretation. In this theoretical comparison, the Genmark ePlex BCID scored higher among both GP and GN organisms. Disclosures All authors: No reported disclosures.

scholarly journals 149. Short vs. Long Course of Antibiotics for Uncomplicated Gram-Negative Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S101-S102
Author(s):  
James Go ◽  
Sarah Cotner ◽  
Donna R Burgess ◽  
David Burgess ◽  
Katie Wallace ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Data Bank ◽  
The United States ◽  
Duration Of Treatment ◽  
Gram Negative ◽  
Short Course ◽  
Days Of Therapy ◽  
Significant Difference ◽  
Gram Negative Bacteremia ◽  
Long Course

Abstract Background Bloodstream infections (BSI) continue to be a major cause of morbidity and mortality in the United States; thus, the correct choice of antibiotics for an appropriate duration is imperative. However, there are limited recommendations on adequate duration of treatment of bacteremia caused by Gram-negative organisms. Therefore, treating an infection for an adequate duration to prevent complications while preventing adverse effects from unnecessary antibiotic exposure remains a balancing act. This study aims to compare clinical outcomes between patients treated with a short (7–10 days) vs. long (11–20 days) course of antibiotics for uncomplicated gram-negative bacteremia. Methods This single-center retrospective cohort study evaluated adult patients admitted between January 2007 to October 2018 with a blood culture positive for gram-negative bacteria. Data came from the University of Kentucky Microbiological Laboratory and Center for Clinical and Translational Science (CCTS) Data Bank. Patients included must have received appropriate antibiotics for at least 7 days. Appropriate antibiotics were defined as those to which the organism is susceptible with day one of therapy as the first day of appropriate antibiotic therapy. Patients were excluded if they were treated with aminoglycoside monotherapy, had polymicrobial bacteremia, or if treated for longer than 20 days of therapy. Results A total of 466 patients were identified (208 in the short-course group and 258 in the long course group). Gender and ethnicity were similar across both groups. The patients in the long course group had more ICU admissions compared with the short-course group (52.7% vs. 43.3%, P = 0.0426), tended to be older (57 ± 16.7 vs. 53 ± 15.9 years, P = 0.0119), had a higher Charlson Comorbidity Index (5.7 ± 3.6 vs. 4.6 ± 3.6, P = 0.0009) and remained admitted to the hospital longer (23.2 ± 25.6 vs. 15.8 ± 17.5 days, P = 0.0002). However, patients treated with a long course had no difference in 30-day mortality compared with the short-course group (3.9% vs. 3.4%, P = 0.7701). Conclusion Patients with an uncomplicated gram-negative BSI treated with a short course (7–10 days) of antibiotics do not appear to have a significant difference in 30-day mortality compared with those patients treated with a long course (11–20 days). Disclosures All authors: No reported disclosures.

scholarly journals The Immunodetection of Non-Falciparum Malaria in Ancient Egyptian Bones (Giza Necropolis)

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Ghada Darwish AL-Khafif ◽  
Rokia El-Banna ◽  
Nancy Khattab ◽  
Tamer Gad Rashed ◽  
Salwa Dahesh
Keyword(s):  
Falciparum Malaria ◽  
Diagnostic Tests ◽  
Social Groups ◽  
Rapid Diagnostic Tests ◽  
Ancient Egypt ◽  
Main Risk Factor ◽  
Old Kingdom ◽  
Ancient Egyptian ◽  
Prolonged Contact ◽  
Significant Difference

The detection of falciparum malaria in ancient Egyptian remains had been performed by many authors using several methodologies including the use of rapid diagnostic tests. Through the immunochromatographic analysis of bony specimens from Giza skeletal collection dated to Old Kingdom, we provide first evidence of non-falciparum malaria in Ancient Egypt. The histidine-rich protein-2 (HRP2) specific toPlasmodium falciparumwas absent in 100% of examined samples, while aldolase, common to the four types of plasmodial pathogens causing human malaria, was detected in 56% of individuals with no significant difference between the two tested social groups: high officials (HO) and workers (W). It is suggested that the main risk factor was the presence of residences near natural and artificial waterways, which allowed prolonged contact between the vector and human host.

scholarly journals 1360. Variation in Duration of Antibiotic Therapy for Central-line Associated Blood Stream Infections Caused by Gram Negative Bacilli in Hospitalized Children

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S691-S691
Author(s):  
Grant R Whitmer ◽  
Tonya Scardina ◽  
Shan Sun ◽  
Xiaotian Zheng ◽  
Sameer Patel
Keyword(s):  
Antibiotic Therapy ◽  
Median Duration ◽  
Positive Culture ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Effective Therapy ◽  
Severe Neutropenia ◽  
Solid Organ ◽  
Gram Negative

Abstract Background Central-line associated bloodstream infections (CLABSIs) are associated with increased morbidity, mortality, and duration of hospitalization in children. Existing guidelines recommend a broad range (7-14 days) for duration of antibiotic therapy. Unnecessarily prolonged therapy may be associated with emergence of antibiotic resistance and adverse events. Methods We performed a retrospective review of all patients diagnosed with CLABSIs caused by Gram negative bacilli (GNB) at our institution from August 2009 to April 2019. CLABSI was defined as isolation of a GNB from the blood &gt;48 hours after hospital admission with presence of a central venous catheter. Children who died before completion of treatment were excluded. Data collection variables included severe neutropenia (defined as absolute neutrophil count &lt; 500), immunocompromised status (defined as receipt of bone marrow transplant, solid organ transplant, or immunosuppressive medication), and catheter removal. The duration of effective antibiotic therapy was calculated from the date of last positive culture to discontinuation. Effective therapy was defined as use of an agent to which the isolated organism was susceptible by antimicrobial susceptibility testing. The primary outcome was microbiological recurrence of the same organism and/or all-cause mortality within 30 days of discontinuation. Results Overall, 95 CLABSIs were included. Of 92 patients, 46 (50%) were immunocompromised. For patients with catheters removed prior to the end of therapy (n=48), the median duration of effective therapy was 13.5 days (IQR: 8.75-16 days). For patients who retained catheters throughout treatment (n=47), the median duration of effective therapy was 13 days (IQR: 9-15 days). Of these 95 CLABSIs, one patient (retained catheter) had microbiological recurrence within 30 days. Seven patients died (without microbiological recurrence), with range of duration of therapy of 6-14 days. Conclusion There was a wide variation in length of therapy for CLABSIs caused by GNB in children. Microbiological recurrence was rare, and mortality was unrelated to microbiological recurrence. Future studies should evaluate standardization of shorter duration therapy to avoid unnecessarily prolonged antibiotic exposure. Disclosures Sameer Patel, MD MPH, Merck (Grant/Research Support)Nexogen (Consultant)

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