scholarly journals Is it actionable? An Evaluation of the Rapid PCR-Based Blood Culture Identification Panel on the Management of Gram-Positive and Gram-Negative Blood Stream Infections

2018 ◽  
Author(s):  
Andrew S. Tseng ◽  
Sabirah N. Kasule ◽  
Felicia Rice ◽  
Lanyu Mi ◽  
Lynn Chan ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antimicrobial Therapy ◽  
Blood Stream ◽  
Gram Positive ◽  
Blood Stream Infections ◽  
Gram Negative ◽  
Discharge Disposition ◽  
Significant Difference ◽  
Culture Identification ◽  
Organism Identification

ABSTRACTBackgroundThere is growing interest in the use of rapid blood culture identification (BCID) panels in antimicrobial stewardship programs (ASP). While many studies have looked at its clinical and economic utility, its comparative utility in gram-positive and gram-negative blood stream infections (BSI) have not been as well characterized.MethodsThe study was a quasi-experimental retrospective study at the Mayo Clinic in Phoenix, Arizona. All adult patients with positive blood cultures before BCID implementation (June 2015 to December 2015) and after BCID implementation (June 2016 to December 2016) were included. The outcomes of interest included: time to first appropriate antibiotic escalation, time to first appropriate antibiotic de-escalation, time to organism identification, LOS, infectious disease consultation, discharge disposition, and in-hospital mortality.ResultsIn total, 203 patients were included in this study. There was a significant difference in the time to organism identification between pre- and post-BCID cohorts (27.1h vs. 3.3h, p<0.0001). BCID did not significantly reduce the time to first appropriate antimicrobial escalation or de-escalation for either GP-BSIs or GN-BSIs. Providers were more likely to escalate antimicrobial therapy in GP-BSIs after gram stain and more likely to de-escalate therapy in GN-BSIs after susceptibilities. While there were no significant differences in changes in antimicrobial therapy after organism identification by BCID, over a quarter of providers (28.1%) made changes after organism identification.ConclusionsWhile BCID significantly reduced the time to identification for both GP-BSIs and GN-BSIs, BCID did not reduce the time to first appropriate antimicrobial escalation and de-escalation.

scholarly journals Is It Actionable? An Evaluation of the Rapid PCR-Based Blood Culture Identification Panel on the Management of Gram-Positive and Gram-Negative Blood Stream Infections

2018 ◽  
Vol 5 (12) ◽  
Author(s):  
Andrew S Tseng ◽  
Sabirah N Kasule ◽  
Felicia Rice ◽  
Lanyu Mi ◽  
Lynn Chan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Hospital Mortality ◽  
Antimicrobial Therapy ◽  
Blood Stream ◽  
Gram Positive ◽  
Blood Stream Infections ◽  
Gram Negative ◽  
Culture Identification ◽  
Organism Identification

Abstract Background There is growing interest in the use of rapid blood culture identification (BCID) in antimicrobial stewardship programs (ASPs). Although many studies have looked at its clinical and economic utility, its comparative utility in gram-positive and gram-negative blood stream infections (BSIs) has not been as well characterized. Methods The study was a quasi-experimental retrospective study at the Mayo Clinic in Phoenix, Arizona. All adult patients with positive blood cultures before BCID implementation (June 2015 to December 2015) and after BCID implementation (June 2016 to December 2016) were included. The outcomes of interest included time to first appropriate antibiotic escalation, time to first appropriate antibiotic de-escalation, time to organism identification, length of stay, infectious diseases consultation, discharge disposition, and in-hospital mortality. Results In total, 203 patients were included in this study. There was a significant difference in the time to organism identification between the pre- and post-BCID cohorts (27.1 hours vs 3.3 hours, P &lt; .0001). BCID did not significantly reduce the time to first appropriate antimicrobial escalation or de-escalation for either gram-positive BSIs (GP-BSIs) or gram-negative BSIs (GN-BSIs). Providers were more likely to escalate antimicrobial therapy in GP-BSIs after gram stain and more likely to de-escalate therapy in GN-BSIs after susceptibilities. Although there were no significant differences in changes in antimicrobial therapy for organism identification by BCID vs traditional methods, more than one-quarter of providers (28.1%) made changes after organism identification. There were no differences in hospital length of stay or in-hospital mortality comparing pre- vs post-BCID. Conclusions Although BCID significantly reduced the time to identification for both GP-BSIs and GN-BSIs, BCID did not reduce the time to first appropriate antimicrobial escalation and de-escalation.

scholarly journals Incidence of secondary blood stream infections in Covid 19 (SARS-nCoV II.) patients

2021 ◽  
Vol 8 (2) ◽  
pp. 128-131
Author(s):  
Asmabanu Shaikh ◽  
Rachana Patel ◽  
Anant Marathe
Keyword(s):  
Blood Culture ◽  
Blood Stream ◽  
Blood Cultures ◽  
Automated System ◽  
Empiric Antibiotic Therapy ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Blood Stream Infections ◽  
Gram Negative ◽  
Gram Positive Bacteria

The symptomatology and severity of covid-19 ranges widely depending on stage of infection. Most of the patients with mild to moderate disease can be managed without hospitalization. The patients with risk factors are likely to progress to severe disease. Patients developing secondary blood stream infections require longer hospital stay and are likely to develop fatal disease. The antibiotic selection is key to successful treatment of secondary BSI. This is cross-sectional study of 166 COVID 19 patients admitted to ICU of Parul Sevashram Hospital who developed sepsis like syndrome and were subjected to blood culture.Blood cultures were performed of all the patients developing sepsis like syndrome. IDSA guidelines were followed during blood collection for culture. Blood cultures were monitored on automated blood culture system. ID and susceptibility of all the isolates were performed on automated system (VITEK 2).A total of 1915 patients were reported RT-PCR positive for SARS nCoV2 during the period of 1st March2020 to 30 October 2020. 452 patients needed hospitalization based on their Oxygen saturation and co-morbidities. Out of 452, 166 patients developed sepsis like syndrome and were subjected to blood culture. The Blood culture positivity was 37/166 (22.28%). Gram positive bacteria were found in 48.64% while gram negative bacteria were 43.24%. The Enterococcus was the most common Gram positive bacterial isolates in patients. Candida was isolated in 2/37 positive blood cultures. Gram negative bacteria were isolated mostly amongst those patients who were on Ventilator. Most of the Gram positive bacteria were sensitive to Clindamycin, Linezolid, Vancomycin, Daptomycin and Teicoplanin.The incidence rate of BSI was high. Early secondary blood stream infections were mostly endogenous. Enterococcus was the most common amongst Gram positive bacteria. Gram negative secondary bacterial infections were more common with patients on ventilator. The susceptibility pattern would help in decision making of empiric antibiotic therapy. Interestingly as described by some authors earlier the relationship between SARS nCoV 2 and Enterococci needs to be studied further.

scholarly journals PATHOGENS CAUSING BLOOD STREAM INFECTIONS

2015 ◽  
Vol 22 (12) ◽  
pp. 1617-1623
Author(s):  
Muhammad Saeed ◽  
Farhan Rasheed ◽  
Fouzia Ashraf ◽  
Shagufta Iram ◽  
Shahida Hussain ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Cardiac Surgery ◽  
Blood Culture ◽  
Blood Stream ◽  
Cross Sectional Study ◽  
Blood Cultures ◽  
Gram Positive ◽  
Cross Sectional ◽  
Blood Stream Infections ◽  
Gram Negative

Blood stream infections (BSI) remain a major cause of debility and death aroundthe world. BSI accounts for 10-20% of all Nosocomial infections. Empirical antimicrobials arebased on the susceptibility pattern of the pathogens isolated in a specific institute from timeto time. We have conducted this study only on cardiac Patients over two & half years of studyduration. Study design: Cross sectional study. Settings: Microbiology Department, Allama IqbalMedical College/Jinnah Hospital, Lahore. Study Period: January 2013 to July 2015. Materials& Methods: A total of 5411 blood culture specimens were collected from cardiac patientsincluding patients admitted to cardiology ward, coronary care unit (CCU), pre-operative andpost-operative cardiac surgery patients. The bottles containing BHI broth were incubated andwere subcultured after 24 hours, 72 hours, 120 hours, and 168 hours on blood and MacConkeyagars. Isolates were further identified with the help of Gram staining, biochemical reactionsand rapid tests like catalase, oxidase, coagulase, Analytical Profile Index (API) 20E and API20NE. Antimicrobial susceptibility of the isolate was carried out on Mueller-Hinton agar byModified Kirby Bauer disc diffusion technique according to the isolate as per recommendationsof Clinical and Laboratory Standards Institute (CLSI) guidelines 2013. Results: Out of total 5411patients, 3958(73.14%) were male, 1453(26.85%) were females. Out of total 5411 Specimens,only 486 (8.98%) were positive for bacterial growth. Out of total 486 positive blood cultures,261 (53.71%) were Gram positive isolates and 225 (46.29%) were Gram negative isolates.Out 486 positive blood cultures, 96 (19.75%) were from cardiology ward, 67 (13.78%) werefrom CCU, 113 (23.25%) were from pre operative cardiac surgery ward, 210 (43.20%) werefrom post operative cardiac surgery ward. Among Gram positives, Staphylococcus Specieswere most common organism isolated from 246 (50.61%) blood culture specimens. AmongGram negatives, Pseudomonas aeruginosa and E.coli were predominant organisms, isolatedfrom 81(16.66%) and 72(14.81%) blood culture specimens respectively. Conclusion: GramPositive isolates were more common as compared to Gram negative isolates. Vancomycin andLinezolid were the most effective drugs among Gram positive isolates. Piperacillin-Tazobactamwas most potent antimicrobial against Pseudomonas aeruginosa. For coli forms Tigecyclinewas most effective drug.

scholarly journals 1022. Evaluating the Impact of GenMark Dx ePlex® Blood Culture Identification (BCID) on Gram-negative Bloodstream Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S602-S603
Author(s):  
Pia Cumagun ◽  
Jeremy Meeder ◽  
Derek Moates ◽  
Hannah Pierce ◽  
Todd P McCarty ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antimicrobial Therapy ◽  
Resistant Bacteria ◽  
Research Support ◽  
Gram Positive ◽  
Negative Spectrum ◽  
Gram Negative ◽  
Material Support ◽  
Organism Identification ◽  
The Impact

Abstract Background The GenMark Dx ePlex BCID Gram-Negative (GN) panel utilizes electrowetting technology to detect the most common causes of GN bacteremia (21 targets) and 6 antimicrobial resistance (AMR) genes from positive blood culture (BC) bottles. Rapid detection of extended spectrum β-lactamases (ESBL: CTX-M & carbapenemases: KPC, NDM, IMP, VIM, OXA 23/48), and highly resistant bacteria such as S. maltophilia should enable early optimization of antimicrobial therapy. Methods In this prospective study, aliquots of positive BC bottles with GN bacteria detected on Gram stain (GS) (n=108) received standard of care (SOC) culture and antimicrobial susceptibility testing (AST). Additionally, samples were evaluated with the BCID-GN panel but only SOC results were reported in the EMR and available to inform clinical decisions. Chart reviews were performed to evaluate the impact of the BCID-GN panel on the time to organism identification, AST results, and optimization of antimicrobial therapy. Results A total of 108 patients are included in the analysis (Table 1). Escherichia coli was the most common bacteria identified followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterobacter species (Table 2). There were 11 (10.2%) polymicrobial bacteremias. Repeat BCs were obtained in 68 (63%) patients of which 13 (19%) were persistently positive. Eight (7%) patients had evidence of additional gram-positive (GP) pathogens. Organism identification occurred 26.7 hours faster than culture. In conjunction with GS, negative pan-GP marker data could have helped providers make the decision to remove GP antibiotic coverage in 63 (58%) patients. Narrowing from empiric meropenem could have occurred in 5 patients. Of 10 individuals infected with resistant isolates (1 S. maltophilia, 1 OXA 23/48, and 8 CTX-M) empiric therapy was ineffective in 4 (40%) cases. Optimization of antimicrobial therapy for 9 (8.3%) patients could have occurred an average of 52.4 hours earlier than standard methods. Table 1. Patient demographics and co-morbidities. Table 2. Gram-negative bacteria frequency. Conclusion The BCID-GN panel enabled earlier time to optimal treatment of highly resistant bacteria as well as multiple opportunities for narrowing gram negative spectrum and a higher degree of certainty in cessation of broad-spectrum gram-positive antibiotics Disclosures Todd P. McCarty, MD, Cidara (Grant/Research Support)GenMark (Grant/Research Support, Other Financial or Material Support, Honoraria for Research Presentation)T2 Biosystems (Consultant) Sixto M. Leal, Jr., MD, PhD, Abnova (Grant/Research Support)AltImmune (Grant/Research Support)Amplyx Pharmaceuticals (Grant/Research Support)Astellas Pharmaceuticals (Grant/Research Support)CNINE Dx (Grant/Research Support)GenMark Diagnostics (Grant/Research Support, Other Financial or Material Support, Honoraria- Research Presentation)IHMA (Grant/Research Support)IMMY Dx (Grant/Research Support)JMI/Sentry (Grant/Research Support)mFluiDx Dx (Grant/Research Support)SpeeDx Dx (Grant/Research Support)Tetraphase Pharmaceuticals (Grant/Research Support)

scholarly journals Susceptibility Pattern of Pathogens Causing Blood Stream Infections in a Tertiary Care Hospital: A Two-year Retrospective Study from Southern Nigeria

2021 ◽  
pp. 53-60
Author(s):  
Bassey Ewa Ekeng ◽  
Ubleni Ettah Emanghe ◽  
Bernard Ekpan Monjol ◽  
Anthony Achizie Iwuafor ◽  
Ernest Afu Ochang ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Blood Stream ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Disc Diffusion ◽  
Blood Stream Infections ◽  
Gram Negative ◽  
Antimicrobial Sensitivity ◽  
Culture Positive

Aim: Bloodstream infections are a major cause of morbidity and mortality worldwide. The prevalence of causative microorganisms varies from one geographical region to another. This study was aimed at determining the etiological agents prevalent in our environment and their susceptibility profile. Study design: This is a retrospective study carried out at the University of Calabar Teaching Hospital, Calabar, Nigeria. Methodology: Blood culture results of patients documented over a two-year period were retrieved and analyzed. Blood culture positive isolates were detected using conventional method and Oxoid signal blood culture systems. Antimicrobial sensitivity tests were carried out by Kirby-Bauer disc diffusion method. Methicillin resistance in Staphylococcus aureus and coagulase negative Staphylococcus species (CoNS) was detected by disk diffusion method using 30 µg cefoxitin disk. ESBL production was detected by phenotypic confirmatory disc diffusion test (PCDDT) and the double disc synergy test (DDST). Results: A total of 413 blood culture antimicrobial susceptibility test results were analyzed, of which 116 (28.09%) were identified as culture positive. Sixty-nine (59%) of the positive isolates were from female patients. Out of 116 positive cultures, 58.62% (68/116) were Gram positive organisms, 40.52% (47/116) were Gram negative organisms, non albicans Candida accounted for 0.86% (1/116).  Staphylococcus aureus (n=41, 35.3%) was the predominant isolate and showed high sensitivity to levofloxacin (100%), Linezolid (100%) and Amikacin (100%). Twelve isolates of S. aureus were methicillin resistant, while 1 isolate was inducible clindamycin resistant. Of the 116 isolates identified in this study, forty-three (43) were multidrug resistant with highest number of multidrug resistant isolates from Staphylococcus aureus (n=20). 21.28% (n=10) of the Gram-negative isolates were positive for extended spectrum beta lactamases. Conclusion: A high rate of antimicrobial resistance is observed among microorganisms causing blood stream infections. This emphasizes the need for antimicrobial sensitivity testing in the management of blood stream infections.

scholarly journals 82. Assessment of Clinical Outcomes and Antibiotic Prescribing Patterns Following Implementation of the GenMark ePlex® Blood Culture Identification Panel for Gram-positive Bloodstream Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S157-S157
Author(s):  
Megan Wein ◽  
Shawn Binkley ◽  
Vasilios Athans ◽  
Stephen Saw ◽  
Tiffany Lee ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Gram Stain ◽  
Gram Positive ◽  
Significant Difference ◽  
Culture Identification ◽  
The Impact

Abstract Background Rapid diagnostic testing (RDT) of bloodstream pathogens provides key information sooner than conventional identification and susceptibility testing. The GenMark ePlex® blood culture identification gram-positive (BCID-GP) panel is a molecular-based multiplex platform, with 20 Gram-positive target pathogens and 4 bacterial resistance genes that can be detected within 1.5 hours of blood culture positivity. Published studies have evaluated the accuracy of the ePlex® BCID-GP panel compared to traditional identification methods; however, studies evaluating the impact of this panel on clinical outcomes and prescribing patterns are lacking. Methods This multi-center, quasi-experimental study evaluated clinical outcomes and prescribing patterns before (December 2018 – June 2019) and after (August 2019 – January 2020) implementation of the ePlex® BCID-GP panel in June 2019. Hospitalized, adult patients with growth of Enterococcus faecalis, Enterococcus faecium, or Staphylococcus aureus from blood cultures were included. The primary endpoint was time to targeted antibiotic therapy, defined as time from positive Gram-stain to antibiotic adjustment for the infecting pathogen. Results A total of 200 patients, 100 in each group, were included. Time to targeted therapy was 47.9 hours in the pre-group versus 24.8 hours in the post-group (p&lt; 0.0001). Time from Gram-stain to organism identification was 23.03 hours (pre) versus 2.56 hours (post), p&lt; 0.0001. There was no statistically significant difference in time from Gram-stain to susceptibility results, hospital length of stay (LOS), or all-cause 30-day mortality. Conclusion Implementation of the GenMark ePlex® BCID-GP panel reduced time to targeted antibiotic therapy by nearly 24 hours. Clinical outcomes including hospital LOS and all-cause 30-day mortality did not show a statistical difference, although analysis of a larger sample size is necessary to appropriately assess these outcomes. This study represents the effect of RDT implementation alone, in the absence of stewardship intervention, on antibiotic prescribing patterns. These findings will inform the design of a dedicated RDT antimicrobial stewardship intervention at our institution, while also being generalizable to other institutions with RDT capabilities. Disclosures All Authors: No reported disclosures

scholarly journals Spectrum of non-fermenting gram negative bacilli isolated from patients with blood stream infections in a tertiary care hospital in North India

2019 ◽  
Vol 7 (5) ◽  
pp. 1762
Author(s):  
Asifa Nazir ◽  
Bushra Yousuf Peerzada ◽  
Ifshana Sana
Keyword(s):  
Blood Culture ◽  
Antibiotic Susceptibility ◽  
Tertiary Care ◽  
Blood Stream ◽  
Control Measures ◽  
Care Hospital ◽  
Susceptibility Pattern ◽  
Intrinsic Resistance ◽  
Blood Stream Infections ◽  
Gram Negative

Background: Non-fermenting Gram-negative bacilli (NFGNB) are emerging as important causes of blood stream infections (BSI) and they are a major cause of morbidity and mortality worldwide. High intrinsic resistance of NFGNB to antimicrobial compounds makes the treatment of BSIs caused by them difficult and expensive. The aim of this study was to assess frequency and antibiotic susceptibility pattern of non-fermenting gram-negative rods isolated from blood culture of patients.Methods: A total of 3016 blood samples were received in the Department of Microbiology during the study period. All samples were processed according to standard microbiological procedures. Blood culture was done by automated blood culture system, (BacT/Alert) and identification and antibiotic susceptibility of non-fermenting gram negative bacilli was done by VITEK2 Compact System.Results: A total of 120 NFGNB were identified out of which the most common non-fermenters isolated were Acinetobacter sp. (95) followed by Pseudomonas aeruginosa (11), Burkholderia cepacia (09) Sternotrophomonas maltophilia (03) and Sphingomonas sp. (02). Most of the non -fermenters were multi drug resistant showing a high level of antibiotic resistance to most of the first- and second-line drugs. The most effective drugs were colistin and tigecycline.Conclusions: This study underlines the need to identify NFGNB in tertiary care hospitals and to monitor their susceptibility pattern to guide the clinician for better care and management of patients. Improved antibiotic stewardship and strict infection control measures especially hand washing need to be implemented to prevent emergence and spread of multidrug resistant NFGNB in health care settings.

Incidence and Outcome of Bacterial Blood Stream Infections in Allotransplanted Patients: Rethinking the Role of Fluoroquinolone Prophylaxis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2223-2223
Author(s):  
Benedetta Rambaldi ◽  
Michele Malagola ◽  
Giuseppe Ravizzola ◽  
Giorgio Giannetta ◽  
Nicola Polverelli ◽  
...  
Keyword(s):  
Stem Cell ◽  
Peripheral Blood ◽  
Antimicrobial Prophylaxis ◽  
Blood Stream ◽  
Gram Positive ◽  
Blood Stream Infections ◽  
Hematopoietic Stem ◽  
Gram Negative ◽  
Positive Group ◽  
E Coli

Abstract Introduction. Blood stream infections (BSIs) represent a common event during allogeneic hematopoietic stem cell transplantation (allo-SCT) and are associated with high rate of mortality. Prophylaxis with fluoroquinolones is commonly adopted to prevent severe infection during the neutropenic phase. The emerging bacterial strains resistant to these antimicrobial agents could lead to change this type of approach. Patients and methods. We retrospectively analyzed positive blood cultures (BCs) from patients allotransplanted from January 2010 to December 2015 within our transplant program. Antimicrobial prophylaxis was conducted with a quinolone during the neutropenic period, acyclovir and fluconazole starting from the day prior to reinfusion until the withdrawn of immunosuppressive therapy and sulfametoxazole/trimethoprim starting from the hematological recovery. GVHD prophylaxis consisted on cyclosporine and methotrexate in all cases, with the addition of ATG in patients transplanted from matched unrelated donor (MUD) or with cord-blood (CB) units. Post-transplant cyclophosphamide was used in the setting of haploidentical donors. At fever onset, BCs were collected from peripheral blood (PB-BCs) and central venous catheter (CVC-BCs). A CVC related infection was defined when a positive CVC-BC proceeded by 2 hours the positivity of PB-BCs. CVC contamination was defined by the presence of positive CVC-BCs and negative PB-BCs. Empirical broad-spectrum antimicrobial therapy was usually conduct with a third or fourth generation cephalosporin with the addiction of a glycopeptide agent, if mucositis occurred. Results. One hundred-sixty-two patients underwent allo-SCT of whom 88 (54%) had acute leukemia (AL); 70 (43%) were transplanted in first CR or up-front; 71 (44%) received a myeloablative conditioning (MAC). The stem cell source was bone marrow (BM) in 33 (20%), peripheral blood stem cells (PBSC) in 122 (75%) and CB in 7 (5%) cases. Donors were matched related donor (MRD) in 58 (36%), MUD in 86 (53%) and alternative (haploidentical or CB) in 18 (11%) cases. The median time to positive BCs since allo-SCT was 13 days (range -4 - +1482). Eighty patients (49%) had a positive BCs, for a total of 119 samples. No difference in the clinical characteristics of patients with or without BSI was detected (Table 1). The median follow up was 399 days (range 21-2039) for the BSI positive group and 437 (range 12-2157) for the BSI negative (p=0.52). In 43 out of 80 patients with BSI (53%) we observed a correlation between the BCs and an organ involvement (mainly the lung in 34% of the cases). Seventy-seven (65%) and 42 (35%) out of 119 BCs were sustained by a Gram positive and a Gram negative agent, respectively. The distribution and the antimicrobial sensitivity of the different species is reported in Table 2. Briefly, S. epidermidis and E. coli were the most frequently isolated Gram positive and Gram negative bacteria, respectively (35% and 20%). 67% of E. coli were ESBL positive and 92% were resistant to fluoroquinolones. Moreover 40% and 90% of P. aeruginosa were resistant to carbapenems and to fluoroquinolones, respectively. Sixty (50%) and 59 (50%) out of 119 BCs were CVC-BCs and PB-BCs, respectively. Regarding positive CVC-BCs, 28 (24%) were CVC related BSIs; CVC contamination was observed in 21 cases (18%). The most common isolate from CVC-BCs was S. epidermidis, with 25 cases (21%). Forty -seven out of 80 patients (59%) in the BSI positive group and 35 out of 82 (43%) in the BSI negative group died (p=0.04). Overall, the infection-related mortality was 19% (15 cases). Species with the higher mortality rate were: P. aeruginosa (50%) and E. faecium (67%). Conclusions: Prophylaxis with fluoroquinolones predominantly selects Gram positive infections the majority of which were CVC related. Infections by Gram negative strains are frequently characterized by multi-antimicrobial agent resistance. These results urge to reconsider the antimicrobial prophylaxis strategy. Prospective surveillance of BSIs is a mainstay in the management of patients addressed to allo-SCT. Disclosures No relevant conflicts of interest to declare.

scholarly journals 285. Evaluation of the ePlex® Blood Culture Identification (BCID) Panels for Gram-positive/Gram-negative bacteria and yeasts

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S143-S143
Author(s):  
Kimberle Chapin ◽  
Giannoula Tansarli
Keyword(s):  
Blood Culture ◽  
Gram Positive ◽  
Gram Negative ◽  
Soc Testing ◽  
Percent Agreement ◽  
Culture Identification ◽  
Reduced Time ◽  
Gram Positive Cocci ◽  
Pna Fish ◽  
Vitek Ms

Abstract Background Multiple methods used for blood culture identification create inconsistent to reporting of critical results. Study aim was to evaluate performance characteristics of the ePlex BCID panels compared to current standard of care (SOC) methods used in our lab. Methods Identification sensitivity and specificity were assessed across all targets detected by the ePlex as well as time to final identification (from time of bottle positive Gram stain) between ePlex and SOC testing. SOC included Xpert MRSA/SA or latex agglutination for Gram-positive cocci in clusters (GPCC), Vitek MS + Accelerate Pheno for Gram-negative rods (GNRs), serotyping or optochin disk ± Vitek MS for Gram-positive cocci in chains (GPC chains), Vitek MS or Vitek-2 for Gram-positive rods (GPR), and PNA-FISH or Vitek MS for yeasts. Results 313 unique prospective blood culture specimens were tested with ePlex BCID panels during a 3-month period (January-March 2020). The positive percent agreement was 100% for GNR (n= 98), S. aureus (n= 42), coagulase-negative staphylococci (n= 38), Group A Streptococcus (n= 3), Group B Streptococcus (n= 5), S. pneumoniae (n= 10), GPR (n= 21), and yeasts (n= 20). There was 1 false negative, (S.mutans) which should have been detected. The negative percent agreement was 100% across all targets except for 1 false positive Corynebacterium spp. In total, 6.7% of blood cultures had an off-panel organism which ePlex did not detect. The median time to final identification was 3 (2 – 4) hrs. for ePlex and calculated for all other SOC methods. Compared to SOC molecular methods, the ePlex reduced time to identification 0.5 h compared to Xpert MRSA/SA, 6.7 h compared to Accelerate Pheno for GNR (but Accelerate Pheno provides susceptibilities), and 3 h compared to PNA-FISH for yeasts (p&lt; 0.05). ePlex compared to non-molecular techniques (MALDI-TOF), SOC for Streptococcus spp. and Enteroococcus spp., the time to final identification was reduced by 24 – 30 hours (p&lt; 0.05). Workflow chart comparison eplex to SOC Time to results eplex vs SOC Conclusion The ePlex BCID system provided highly accurate identification results for GP and GN bacteria as well as for yeasts. Our evaluation showed that this system significantly reduced time to final identification compared to SOC testing methods. Disclosures Kimberle Chapin, MD, genmark (Scientific Research Study Investigator) Giannoula Tansarli, MD, GenMark (Grant/Research Support)

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