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 151. Comparing the Clinical Utility of Rapid Diagnostic Tests for Gram-Negative Bloodstream Infection Using a Desirability of Outcomes Ranking

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S102-S102
Author(s):  
Kimberly C Claeys ◽  
Kathryn Schlaffer ◽  
Zegbeh Kpadeh-Rogers ◽  
Yunyun Jiang ◽  
Scott R Evans ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Scoring System ◽  
Clinical Utility ◽  
Medical Center ◽  
Credit Scoring ◽  
Small Sample ◽  
Clinical Microbiology Laboratory ◽  
Partial Credit ◽  
Gram Negative ◽  
Organism Identification

Abstract Background Rapid diagnostic testing (RDT) technology in bloodstream infections (BSI) has outpaced provider understanding of how to effectively use it. To optimize the use of RDT platforms and antibiotic therapy, decision makers must determine which RDTs to implement at their institutions. A thorough understanding of which platform to choose extends beyond simple analytic measures of sensitivities and specificities and should include a robust analysis of how these RDTs could impact clinical decisions. Methods Retrospective study of adult patients with Gram-negative (GN) BSI from at University of Maryland Medical Center. The clinical microbiology laboratory used Verigene® BC-GN in clinical practice. Discarded blood samples were run on BioFire® FilmArray BCID. Final organism identification/susceptibility, antibiotic exposures, and clinical outcomes were reviewed. DOOR was applied to theoretical therapy decisions based on both actual prescribing adherence to institutional algorithm recommendations; 1 being most and 6 being least desirable (Table 1). A partial credit scoring system was applied to DOOR from most (100) to least desirable (0) outcome. Comparisons were made in a paired manner. Results 77 patients met inclusion. The median age was 58 (IQR 47, 68), 44.2% were in the ICU, and 75.3% had ID consult within 24 hours of BSI. Organism identification included: E. coli (35.1%), K. pneumoniae (23.4%), P. mirabilis (10.4%), S. marcescens (10.4%), Enterobacter spp. (9.4%), P. aeruginosa (3.9%). The only resistance determinant was CTX-M (11.6%). An antibiotic change occurred in 26.2% of cases, divided between antibiotic escalation and de-escalation. Based on the actual utilization of RDT results, median DOOR was not different between BC-GN and BCID (3 [IQR 3.4] vs. 4 [IQR 3.4], P = 0.44). Using a partial credit scoring system, the mean score was not different between platforms (49.8 [SD 26.8] vs. 47.7 [SD 20.3], P = 0.44). Through pairwise comparisons, BC-GN would have resulted in an optimal outcome of 15.3% (95% CI 4.7% to 19.3%) more often than BCID. Conclusion Based on the actual use of RDTs for GN BSI there was no difference in potential clinical outcomes between platforms in this relatively small sample. DOOR is a novel mechanism to quantitate clinical utility and compare RDTs. Disclosures All authors: No reported disclosures.

scholarly journals Comparing the clinical utility of rapid diagnostics for the treatment of Bloodstream Infections using Desirability of Outcome Ranking approach for the Management of Antibiotic Therapy (DOOR-MAT)

2021 ◽  
Author(s):  
Kimberly C. Claeys ◽  
Teri L. Hopkins ◽  
Kathryn Schlaffer ◽  
Stephanie Hitchcock ◽  
Yunyun Jiang ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antimicrobial Therapy ◽  
Clinical Utility ◽  
Credit Scoring ◽  
Bloodstream Infections ◽  
Rapid Diagnostic Tests ◽  
Research Use ◽  
Rapid Diagnostics ◽  
University Of Maryland ◽  
The Mean

Background: Decisions regarding which rapid diagnostic tests (RDT) for bloodstream infections to implement remains challenging given the diversity of organisms detected by different platforms. We used the Desirability of Outcome Ranking Management of Antimicrobial Therapy (DOOR-MAT) as a framework to compare two RDT platforms on potential desirability of antimicrobial therapy decisions. Methods: An observational study was performed at University of Maryland Medical System comparing Verigene Blood Culture (BC) to GenMark Dx ePlex Blood Culture ID (BCID) (Research Use Only) panels on blood cultures from adult patients. Positive percent agreement (PPA) between each RDT platform and Vitek MS was calculated for comparison of on-panel targets. Theoretical antimicrobial decisions were made based on RDT results, taking into consideration patient parameters, antimicrobial stewardship practices, and local infectious diseases epidemiology. DOOR-MAT with a partial credit scoring system was applied to these decisions and mean scores compared across platforms using paired t-test. Results: The study consisted of 160 unique patients. The Verigene BC PPA was 98.6% (95% CI 95.1, 99.8) and ePlex BCID PPA was 98% (95% CI 94.3, 99.6). Among the 31 organisms not on the Verigene BC panels, 61% were identified by the ePlex BCID Panels. The mean (standard deviation [SD]) DOOR-MAT score for Verigene BC was 86.8 (SD ± 28.5) versus ePlex BCID was 91.9 (SD ± 23.1), P = 0.01. Conclusion: Both RDT platforms had high PPA for on-panel targets. The ePlex BCID was able to identify more organisms than Verigene, resulting in higher mean DOOR-MAT scores.

scholarly journals Impact of Inactive Empiric Antimicrobial Therapy on Inpatient Mortality and Length of Stay

2006 ◽  
Vol 50 (10) ◽  
pp. 3355-3360 ◽  
Author(s):  
Kimberly K. Scarsi ◽  
Joe M. Feinglass ◽  
Marc H. Scheetz ◽  
Michael J. Postelnick ◽  
Maureen K. Bolon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bloodstream Infections ◽  
Empiric Therapy ◽  
Inpatient Mortality ◽  
In Vitro Susceptibility ◽  
Empiric Antimicrobial Therapy

ABSTRACT The consequences of inactive empiric antimicrobial therapy are not well-described and may cause prolonged hospitalization or infection-related mortality. In vitro susceptibility results for 884 patients hospitalized at an academic medical center with gram-negative bloodstream infections (GNBI) from 2001 to 2003 were matched to antimicrobial orders within 24 h of culture. Clinical characteristics, organism, inpatient mortality, and length of stay after culture for patients with GNBI were compared between patients receiving active versus inactive empiric antimicrobial therapy. A total of 14.1% of patients with GNBI received inactive empiric therapy, defined as no antimicrobial therapy within 24 h of the culture active against the identified organism based on in vitro microbiology reports. Patients who received inactive therapy were more likely to be younger, to be infected with Pseudomonas aeruginosa, to have a nosocomial infection, and to receive antimicrobial monotherapy but less likely to be bacteremic with Escherichia coli or to have sepsis (P < 0.05). There were no significant differences in mortality between patients receiving active versus inactive empiric therapy (16.1% versus 13.6%, respectively) or in length of stay after positive culture (11.5 days versus 12.6 days, respectively). Only 45 patients had greater than 2 days of exposure to inactive therapy; however, 8/30 patients (26.7%) who never received active antimicrobial therapy died while in the hospital. Inactive empiric therapy was more common in healthier patients. Inactive antimicrobial therapy in the first 24 h did not significantly impact average outcomes for GNBI among hospitalized patients but may have caused harm to specific individuals.

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 Predictors of Time to Effective and Optimal Antimicrobial Therapy in Patients With Positive Blood Cultures Identified via Molecular Rapid Diagnostic Testing

2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Maya Beganovic ◽  
Tristan T Timbrook ◽  
Sarah M Wieczorkiewicz
Keyword(s):  
Patient Outcomes ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Diagnostic Tests ◽  
Diagnostic Testing ◽  
Rapid Diagnostic Tests ◽  
Blood Cultures ◽  
Effective Therapy ◽  
Rapid Diagnostic Testing ◽  
Optimal Therapy

Abstract Antimicrobial stewardship (AMS) programs integrated with rapid diagnostic tests optimize patient outcomes and reduce time to effective therapy (TTET) and time to optimal therapy (TTOT). This study identifies predictors of TTET and TTOT among patients with positive blood cultures and identifies limitations to current TTOT definitions and outcomes.

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) &lt; 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 1032. Evaluation of a Multiplex Rapid Diagnostic Panel in Respiratory Specimens from Critically Ill Patients with Hospital-Acquired Pneumonia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S606-S607
Author(s):  
Bradley J Erich ◽  
Abdullah Kilic ◽  
Elizabeth Palavecino ◽  
John Williamson ◽  
James Johnson ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Diagnostic Tests ◽  
Clinical Decision Making ◽  
Medical Center ◽  
Academic Medical Center ◽  
Rapid Diagnostic Tests ◽  
Treatment Team ◽  
Hospital Acquired Pneumonia ◽  
The Cost ◽  
Hospital Acquired

Abstract Background Rapid diagnostic tests can be a valuable aide in clinical decision-making but often cost more than traditional cultures. Prior to its implementation at our institution, we sought to evaluate the potential clinical and financial impact of using the FilmArray® Pneumonia Panel® (FP panel) in patients with hospital-acquired pneumonia (HAP). Methods This was a retrospective, observational, comparative study conducted at an 885-bed academic medical center. Respiratory samples obtained by bronchoalveolar lavage or tracheal aspiration from adult intensive care unit (ICU) patients with a diagnosis of HAP from Nov 2019 – Feb 2020 were tested by the FP panel in addition to routine cultures. Medical records were reviewed to determine potential changes in antimicrobial therapy if FP panel results were known by the treatment team in real time. A cost analysis was also performed incorporating the cost of the FP panel and the savings associated with the potential avoidance of antibiotics and other rapid diagnostic tests normalized per patient. Results 56 patients met study criteria. FP panel results could have prompted a change in therapy in 36 (64.3%) patients, with a mean reduction in time to optimized therapy of approximately 51 hours. The panel identified 3 cases where the causative pathogen was not treated by empiric therapy and 34 opportunities for antibiotic de-escalation, the most common being the discontinuation of empiric vancomycin. 36 patients had been tested with a Respiratory Virus Panel, which could have been avoided if the FP panel was used. The potential therapy impact based on specific ICU and respiratory culture results is summarized in Table 1. The cost analysis calculated an additional cost of &10 per patient associated with using the FP panel. Table 1. Potential Changes in Therapy Based on Patient Location and Culture Result Conclusion The FP panel could have prompted a change in therapy in about two-thirds of patients studied. Its potential benefits include quicker time to optimized therapy, reduced exposure to and cost of broad-spectrum antimicrobials, and reduced cost of other rapid diagnostic tests. Disclosures James Johnson, PharmD, FLGT (Shareholder) Vera Luther, MD, Nothing to disclose

scholarly journals Economic considerations support C-reactive protein testing alongside malaria rapid diagnostic tests to guide antimicrobial therapy for patients with febrile illness in settings with low malaria endemicity

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Yoel Lubell ◽  
Arjun Chandna ◽  
Frank Smithuis ◽  
Lisa White ◽  
Heiman F. L. Wertheim ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Therapy ◽  
Diagnostic Tests ◽  
Distribution Systems ◽  
Point Of Care ◽  
Febrile Illness ◽  
Cost Effective ◽  
Rapid Diagnostic Tests ◽  
C Reactive Protein ◽  
Reactive Protein

AbstractMalaria is no longer a common cause of febrile illness in many regions of the tropics. In part, this success is a result of improved access to accurate diagnosis and effective anti-malarial treatment, including in many hard-to-reach rural areas. However, in these settings, management of other causes of febrile illness remains challenging. Health systems are often weak and other than malaria rapid tests no other diagnostics are available. With millions of deaths occurring annually due to treatable bacterial infections and the ever increasing spread of antimicrobial resistance, improvement in the management of febrile illness is a global public health priority. Whilst numerous promising point-of-care diagnostics are in the pipeline, substantial progress can be made in the interim with existing tools: C-reactive protein (CRP) is a highly sensitive and moderately specific biomarker of bacterial infection and has been in clinical use for these purposes for decades, with dozens of low-cost devices commercially available. This paper takes a health-economics approach to consider the possible advantages of CRP point-of-care tests alongside rapid diagnostic tests for malaria, potentially in a single multiplex device, to guide antimicrobial therapy for patients with febrile illness. Three rudimentary assessments of the costs and benefits of this approach all indicate that this is likely to be cost-effective when considering the incremental costs of the CRP tests as compared with either (i) the improved health outcomes for patients with bacterial illnesses; (ii) the costs of antimicrobial resistance averted; or (iii) the economic benefits of better management of remaining malaria cases and shorter malaria elimination campaigns in areas of low transmission. While CRP-guided antibiotic therapy alone cannot resolve all challenges associated with management of febrile illness in remote tropical settings, in the short-term a multiplexed CRP and malaria RDT could be highly cost-effective and utilize the well-established funding and distribution systems already in place for malaria RDTs. These findings should spark further interest amongst industry, academics and policy-makers in the development and deployment of such diagnostics, and discussion on their geographically appropriate use.

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