Cost-effectiveness of rapid laboratory-based mass-spectrometry diagnosis of bloodstream infection: evidence from the RAPIDO randomised controlled trial

Objectives and interventionBloodstream infection, the presence of viable micro-organisms in the blood, is a prevalent clinical event associated with substantial mortality. Patient outcomes may be improved when the causative micro-organism is identified quickly. We assessed the cost-effectiveness of rapid microbial identification by matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) mass spectrometry.DesignEconomic evaluation alongside a randomised multicentre trial (RAPIDO: RAPId Diagnosis on Outcome) assessing the impact of rapid identification by MALDI-TOF spectrometry.SettingAdult inpatients with bloodstream infections at seven National Health Service hospital trusts in England and Wales.Primary outcomeNet monetary benefit, estimated as incremental costs compared with incremental 28-day survival, of rapid identification by MALDI-TOF spectrometry compared with conventional identification.MethodsPatients were randomised (1:1) to receive diagnosis by conventional methods of microbial identification (conventional arm) only or by MALDI-TOF spectrometry in addition to conventional identification (RAPIDO arm).ResultsData from 5550 patients were included in primary analysis. Mean imputed costs in 2018/2019 prices per patient were lower by £126 in the RAPIDO arm (95% CI −£784 to £532) but the proportion of patients alive at day 28 was lower (81.4% vs 82.3%). The probability of cost-effectiveness of MALDI-TOF was <0.5 at cost-effectiveness thresholds between £20 000 and £50 000.ConclusionsAdjunctive MALDI-TOF diagnosis was unlikely to be cost-effective when measured as cost per death avoided at 28 days. However, the differences between arms in cost and effect were modest, associated with uncertainty and may not accurately reflect ‘real-world’ routine use of MALDI-TOF technology in this patient group.Trial registration numbersISRCTN97107018/UKCRN 11978.

Download Full-text

Catheter-related Mycobacterium fortuitum Bloodstream Infection: Rapid Identification Using MALDI-TOF Mass Spectrometry

Klinische Pädiatrie ◽

10.1055/s-0033-1363959 ◽

2014 ◽

Vol 226 (02) ◽

pp. 68-71 ◽

Cited By ~ 1

Author(s):

M. Artacho-Reinoso ◽

P. Olbrich ◽

P. Solano-Paéz ◽

P. Ybot-Gonzalez ◽

J. Lepe ◽

...

Keyword(s):

Mass Spectrometry ◽

Bloodstream Infection ◽

Rapid Identification ◽

Mycobacterium Fortuitum ◽

Maldi Tof Mass Spectrometry ◽

Maldi Tof

Download Full-text

Erysipelothrix rhusiopathiae bacteremia without endocarditis: rapid identification from positive blood culture by MALDI-TOF mass spectrometry. A case report and literature review

Infectious Disease Reports ◽

10.4081/idr.2016.6368 ◽

2016 ◽

Vol 8 (1) ◽

Cited By ~ 10

Author(s):

Luigi Principe ◽

Silvia Bracco ◽

Carola Mauri ◽

Silvia Tonolo ◽

Beatrice Pini ◽

...

Keyword(s):

Mass Spectrometry ◽

Susceptibility Testing ◽

Bloodstream Infections ◽

Rapid Identification ◽

Erysipelothrix Rhusiopathiae ◽

Maldi Tof Mass Spectrometry ◽

Maldi Tof ◽

High Incidence ◽

Appropriate Therapy ◽

Cutaneous Form

Erysipelothrix rhusiopathiae is a Gram-positive bacillus that is infrequently responsible for infections in humans. Three forms have been classified: a localized cutaneous form (erysipeloid) caused by traumatic penetration of E. rhusiopathiae, a generalized cutaneous form and a septicemic form. The latter type of disease has been previously associated with a high incidence of endocarditis. Here we report a case of E. rhusiopathiae bacteremia in a 74- year-old man, probably started from an erysipeloid form, in which endocarditis did not develop. This case presents some particular and uncommon features: i) no correlation with animal source; ii) correlation between bacteremia and erysipeloid lesion; iii) absence of endocarditis. MALDI-TOF mass spectrometry allowed to obtain a rapid identification (within 4 hours from bottle positivity) of E. rhusiopathiae. Together with direct antimicrobial susceptibility testing, this approach could improve the rate of appropriate therapy for bloodstream infections due to this fastidious pathogen.

Download Full-text

A randomised controlled trial exploring the impact of a dedicated Health and Social Care Professionals team in the Emergency Department on the quality, safety, clinical and cost-effectiveness of care for older adults: Study Protocol

10.21203/rs.2.12207/v2 ◽

2019 ◽

Author(s):

Marica Cassarino ◽

Katie Robinson ◽

Íde O’Shaughnessy ◽

Eimear Smalle ◽

Stephen White ◽

...

Keyword(s):

Older Adults ◽

Cost Effectiveness ◽

Randomised Controlled Trial ◽

Hospital Admissions ◽

Controlled Trial ◽

Health And Social Care ◽

Effectiveness Of Care ◽

Randomised Controlled ◽

The Impact

Abstract Background : Older people are frequent Emergency Department (ED) users who present with complex issues that are linked to poorer health outcomes post-index visit, often have increased ED length of stay and tend to have raised healthcare costs. Encouraging evidence suggests that ED teams involving health and social care professionals (HSCPs) can contribute to enhanced patient flow and improved patient experience by improving care decision-making and thus promoting timely and effective care. However, the evidence supporting the impact of HSCPs teams assessing and intervening with older adults in the ED is limited and identifies important methodological limitations, highlighting the need for more robust and comprehensive investigations of this model of care. This study aims to evaluate the impact of a dedicated ED-based HSCP team on the quality, safety, clinical and cost-effectiveness of care of older adults when compared to usual care. Methods : The study is a single-site randomised controlled trial whereby patients aged ≥65 years who present to the ED of a large Irish hospital will be randomised to the experimental group (ED-based HSCP assessment and intervention) or the control group (usual ED care). The recruitment target is 320 participants. The HSCP team will provide a comprehensive functional assessment as well as interventions to promote a safe discharge for the patient. The primary outcome is ED length of stay (from arrival to discharge). Secondary outcomes include: rates of hospital admissions from the ED, ED re-visits, unplanned hospital admissions and healthcare utilisation at 30-days, four and six-month follow-up; patient functional status and quality of life (at baseline and follow-up); patient satisfaction; costs-effectiveness in terms of costs associated with ED-based HSCP compared to usual care; and perceptions on implementation by ED staff members. Discussion : This is the first randomised controlled trial testing the impact of HSCPs working in teams in the ED on the quality, safety, clinical and cost-effectiveness of care for older patients. The findings of the study will provide important information on the effectiveness of this model of care for future implementation. Trial registration : ClinicalTrials.gov, NCT03739515; registered on 12 th November 2018. Protocol version 1. URL: https://clinicaltrials.gov/ct2/show/NCT03739515

Download Full-text

A differential centrifugation protocol and validation criterion for enhancing mass spectrometry (MALDI-TOF) results in microbial identification using blood culture growth bottles

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-012-1797-1 ◽

2012 ◽

Vol 32 (5) ◽

pp. 699-704 ◽

Cited By ~ 30

Author(s):

G. A. March–Rosselló ◽

M. F. Muñoz–Moreno ◽

M. C. García-Loygorri–Jordán de Urriés ◽

M. A. Bratos–Pérez

Keyword(s):

Mass Spectrometry ◽

Blood Culture ◽

Differential Centrifugation ◽

Microbial Identification ◽

Maldi Tof ◽

Validation Criterion ◽

Culture Growth ◽

Centrifugation Protocol

Download Full-text

MALDI-TOF Mass Spectrometry for Rapid Identification of Highly Pathogenic Microorganisms

BSL3 and BSL4 Agents ◽

10.1002/9783527638192.ch17 ◽

2011 ◽

pp. 179-212 ◽

Cited By ~ 3

Author(s):

Peter Lasch ◽

Dieter Naumann

Keyword(s):

Mass Spectrometry ◽

Rapid Identification ◽

Pathogenic Microorganisms ◽

Highly Pathogenic ◽

Maldi Tof Mass Spectrometry ◽

Maldi Tof

Download Full-text

Use of MALDI-TOF mass spectrometry in rapid identification of Beauveria bassiana and Beauveria pseudobassiana

Journal of Central European Agriculture ◽

10.5513/jcea01/19.2.2151 ◽

2018 ◽

Vol 19 (2) ◽

pp. 394-407 ◽

Cited By ~ 1

Author(s):

Nikola HRICÁKOVÁ ◽

Juraj MEDO ◽

Lukáš HLEBA ◽

Marek BARTA ◽

Jana MAKOVÁ

Keyword(s):

Mass Spectrometry ◽

Beauveria Bassiana ◽

Rapid Identification ◽

Maldi Tof Mass Spectrometry ◽

Maldi Tof

Download Full-text

MALDI-TOF mass spectrometry for rapid identification of clinical fungal isolates based on ribosomal protein biomarkers

Journal of Microbiological Methods ◽

10.1016/j.mimet.2014.12.014 ◽

2015 ◽

Vol 109 ◽

pp. 93-105 ◽

Cited By ~ 43

Author(s):

Ashutosh Panda ◽

Anup K. Ghosh ◽

Bijay R. Mirdha ◽

Immaculata Xess ◽

Saikat Paul ◽

...

Keyword(s):

Mass Spectrometry ◽

Ribosomal Protein ◽

Rapid Identification ◽

Protein Biomarkers ◽

Maldi Tof Mass Spectrometry ◽

Maldi Tof ◽

Fungal Isolates

Download Full-text

Performances and Reliability of Bruker Microflex LT and VITEK MS MALDI-TOF Mass Spectrometry Systems for the Identification of Clinical Microorganisms

BioMed Research International ◽

10.1155/2015/516410 ◽

2015 ◽

Vol 2015 ◽

pp. 1-18 ◽

Cited By ~ 11

Author(s):

Kivanc Bilecen ◽

Gorkem Yaman ◽

Ugur Ciftci ◽

Yahya Rauf Laleli

Keyword(s):

Mass Spectrometry ◽

Clinical Microbiology ◽

Identification Accuracy ◽

Clinical Microbiology Laboratory ◽

Maldi Tof Ms ◽

Microbial Identification ◽

Phenotypic Identification ◽

Maldi Tof ◽

Vitek Ms ◽

Tof Ms

In clinical microbiology laboratories, routine microbial identification is mostly performed using culture based methodologies requiring 24 to 72 hours from culturing to identification. Matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) technology has been established as a cost effective, reliable, and faster alternative identification platform. In this study, we evaluated the reliability of the two available MALDI-TOF MS systems for their routine clinical level identification accuracy and efficiency in a clinical microbiology laboratory setting. A total of 1,341 routine phenotypically identified clinical bacterial and fungal isolates were selected and simultaneously analyzed using VITEK MS (bioMérieux, France) and Microflex LT (Bruker Diagnostics, Germany) MALDI-TOF MS systems. For any isolate that could not be identified with either of the systems and for any discordant result, 16S rDNA gene or ITS1/ITS2 sequencing was used. VITEK MS and Microflex LT correctly identified 1,303 (97.17%) and 1,298 (96.79%) isolates to the species level, respectively. In 114 (8.50%) isolates initial phenotypic identification was inaccurate. Both systems showed a similar identification efficiency and workflow robustness, and they were twice as more accurate compared to routine phenotypic identification in our sample pool. MALDITOF systems with their accuracy and robustness offer a good identification platform for routine clinical microbiology laboratories.

Download Full-text