Impact of Direct From Blood Culture Identification of Pathogens Paired With Antimicrobial Stewardship Interventions in a Pediatric Hospital

OBJECTIVE Identification of organisms directly from positive blood culture by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has the potential for improved clinical outcomes through earlier organism identification and shorter time to appropriate clinical intervention. The uses of this technology in pediatric patients and its impact in this patient population have not been well described. METHODS Direct from positive blood culture organism identification via MALDI-TOF was implemented in September 2019. A quality improvement project was performed to assess its impact on admissions for contaminant blood cultures and time to effective and optimal antimicrobials and clinical decision-making. A pre- and post-implementation retrospective review for consecutive September through February time periods, was conducted on patients with positive monomicrobial blood cultures. Statistics were evaluated using Mann-Whitney U and χ2 tests. RESULTS One hundred nineteen patients with 131 unique blood cultures (65 in pre- and 66 in post-implementation) were identified. Time to identification was shorter, median 35.4 hours (IQR, 22.7–54.3) versus 42.3 hours (IQR, 36.5–49) in post- and pre-groups, respectively (p = 0.02). Patients were less likely to be admitted for a contaminated blood culture in the post-implementation, 26% versus 11% in the pre-implementation (p = 0.03) group. In patients treated for bacteremia, there was a shorter time to optimal therapy from Gram stain reporting in the post-implementation (median 42.7 hours [IQR, 27.2–72]) versus pre-implementation (median 60.8 hours [IQR, 42.9–80.6]) (p = 0.03). CONCLUSIONS Direct from positive blood culture identification by MALDI-TOF decreased time to effective and optimal antimicrobials and decreased unnecessary admission in pediatric patients for contaminated blood cultures.

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Comparison between MALDI-TOF MS and FilmArray Blood Culture Identification panel for rapid identification of yeast from positive blood culture

Journal of Microbiological Methods ◽

10.1016/j.mimet.2014.06.018 ◽

2014 ◽

Vol 104 ◽

pp. 92-93 ◽

Cited By ~ 16

Author(s):

M. Paolucci ◽

C. Foschi ◽

M.V. Tamburini ◽

S. Ambretti ◽

T. Lazzarotto ◽

...

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Rapid Identification ◽

Maldi Tof Ms ◽

Maldi Tof ◽

Culture Identification ◽

Tof Ms

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An Evaluation Of Direct Identification Of Pathogens From Blood Cultures By Maldi-Tof Mass Spectrometry

Sveikatos mokslai ◽

10.5200/sm-hs.2016.074 ◽

2016 ◽

Vol 26 (5) ◽

pp. 69-73

Author(s):

Lina Savickaitė ◽

Jelena Kopeykinienė

Keyword(s):

Mass Spectrometry ◽

Blood Culture ◽

Positive Blood Culture ◽

Antimicrobial Therapy ◽

Rapid Identification ◽

Blood Cultures ◽

Direct Identification ◽

Maldi Tof Mass Spectrometry ◽

Maldi Tof ◽

Mass Spectrometry Identification

Rapid identification of the infecting organism may aid in choosing appropriate antimicrobial therapy. We used MALDI-TOF mass spectrometry to identify bacteria directly from the positive blood culture samples (n=21). 85,71 percent of these results was identified using of MALDI-TOF mass spectrometry. Identification time of bacteria directly from the blood culture takes more than 1 hour for 27,8 percent results.

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Comparison of the Fully Automated FilmArray BCID Assay to a 4-Hour Culture Test Coupled to Mass Spectrometry for Day 0 Identification of Microorganisms in Positive Blood Cultures

BioMed Research International ◽

10.1155/2018/7013470 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Paul O. Verhoeven ◽

Cyrille H. Haddar ◽

Josselin Rigaill ◽

Nathalie Fonsale ◽

Anne Carricajo ◽

...

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Blood Stream Infection ◽

Blood Stream ◽

Bacterial Identification ◽

Maldi Tof Ms ◽

Maldi Tof ◽

Negative Results ◽

Culture Identification ◽

Tof Ms

Rapid bacterial identification of positive blood culture is important for adapting the antimicrobial therapy in patients with blood stream infection. The aim of this study was to evaluate the performance of the multiplex FilmArray Blood Culture Identification (BCID) assay by comparison to an in-house protocol based on MALDI-TOF MS identification of microcolonies after a 4-hour culture, for identifying on the same day the microorganisms present in positive blood culture bottles. One hundred and fifty-three positive bottles from 123 patients were tested prospectively by the 3 techniques of bacterial identification: 11 bottles yielding negative results by the 3 tests were considered false positive (7.2%). The reference MALDI-TOF MS technique identified 134 monomicrobial (87.6%) and 8 double infections (5.2%), which resulted in a total of 150 microorganisms. Globally, 137 (91.3%) of these 150 pathogens were correctly identified by the fully automated multiplex FilmArray BCID system at the species or genus level on day of growth detection, versus 117 (78.8%) by MALDI-TOF MS identification on nascent microcolonies after a 4-hour culture (P < 0.01). By combining the two approaches, 140 (93.5%) of the positive bottles were identified successfully at day 0. These results confirm the excellent sensitivity of the FilmArray BCID assay, notably in case of multimicrobial infection. Due to the limited number of targets included into the test, it must be coupled to another identification strategy, as that presented in this study relying on MALDI-TOF MS identification of microcolonies obtained after a very short culture period.

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Clinical consequences of contaminated blood cultures in adult hospitalized patients at an institution utilizing a rapid blood-culture identification system

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1337 ◽

2020 ◽

pp. 1-7

Author(s):

Sidra Liaquat ◽

Lorena Baccaglini ◽

Gleb Haynatzki ◽

Sharon J. Medcalf ◽

Mark E. Rupp

Keyword(s):

Blood Culture ◽

Antibiotic Therapy ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Blood Cultures ◽

Hospitalized Patients ◽

Identification System ◽

Negative Blood Culture ◽

Culture Identification ◽

Contaminated Blood

Abstract Objective: To assess the clinical impact of contaminated blood cultures in hospitalized patients during a period when rapid diagnostic testing using a FilmArray Blood Culture Identification (BCID) panel was in use. Design: Retrospective cohort study. Setting: Single academic medical center. Participants: Patients who had blood culture(s) performed during an admission between June 2014 and December 2016. Methods: Length of hospital stay and days of antibiotic therapy were assessed in relation to blood-culture contamination using generalized linear models with univariable and multivariable analyses. Results: Among 11,474 patients who had blood cultures performed, the adjusted mean length of hospital stay for patients with contaminated blood-culture episodes (N = 464) was 12.3 days (95% confidence interval [CI], 11.4–13.2) compared to 11.5 days (95% CI, 11.0–11.9) for patients (N = 11,010) with negative blood-culture episodes (P = .032). The adjusted mean durations of antibiotic therapy for patients with contaminated and negative blood-culture episodes were 6.0 days (95% CI, 5.3–6.7) and 5.2 days (95% CI, 4.9–5.4), respectively (P = .011). Conclusions: Despite the use of molecular-based, rapid blood-culture identification, contamination of blood cultures continues to result in prolonged hospital stay and unnecessary antibiotic therapy in hospitalized patients.

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160. Could Reducing Time to Bacterial Identification From Positive Blood Cultures Improve Outcomes in Bacteremic Patients?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.235 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S105-S105

Author(s):

Jessica D Forbes ◽

Reem Haj ◽

Linda R Taggart ◽

Ramzi Fattouh ◽

Elizabeth Leung ◽

...

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Patient Management ◽

Diagnostic Testing ◽

Empiric Therapy ◽

Central Line ◽

Blood Cultures ◽

Antibiotic Administration ◽

Organism Identification ◽

The Impact

Abstract Background Survival of patients with septic shock is dependent on the timing of effective antibiotic administration. The initial notification by the microbiology lab of a positive blood culture is a key factor in improving patient outcomes. It can take >24 hours to definitively identify bacteria from positive blood cultures. Accordingly, we employed rapid organism identification and studied the impact of this on patient management from a quality improvement perspective. Methods Rapid organism identification was performed for bacteremic patients admitted to an ICU at St. Michael’s Hospital in Toronto, ON, by creating a pellet from positive blood culture bottles using a lysis centrifugation technique. MALDI-TOF was then used to obtain an organism identification. The microbiology lab verbally notified the ward clerk of the identification and surveys were conducted with treating physicians within 24–48 hours to evaluate the downstream impact of the rapid identification including changes to antibiotics, diagnostic testing, central line management and requests for specialty consultations. Results Between January 28 and April 28, 2019, 17 rapid blood culture results were included for study. When asked how physicians received the result, in 7 cases the physician did not remember; other responses included microbiology report (2), nurse (2), pharmacist (1), antimicrobial stewardship or lab (1), on-call team (1) and residents (1). Antibiotics were adjusted in 13 patients; 3 of which may have changed antibiotics for reasons other than the organism identification. Reasons for not changing therapy include: appropriate empiric treatment, likely contaminants, or physician not being notified of the result. In 5 cases, all antibiotics were discontinued, in another 2 cases the antibiotics were broadened and a further 5 narrowed to cover the organism; the remaining 5 continued the same empiric therapy. Repeat blood cultures were obtained for 5 cases, follow-up imaging in 5 cases and lines were changed/removed in 5 cases. Consultation was requested for 7 cases. Conclusion Based on preliminary data, rapid organism identification shows promise of improved patient management with line removal and antibiotics adjustments occurring 1 day sooner with rapid results. Disclosures All authors: No reported disclosures.

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The impact of blood culture identification by MALDI-TOF MS on the antimicrobial management of pediatric patients

Diagnostic Microbiology and Infectious Disease ◽

10.1016/j.diagmicrobio.2018.05.021 ◽

2018 ◽

Vol 92 (3) ◽

pp. 220-225 ◽

Cited By ~ 6

Author(s):

Sejal Makvana Bhavsar ◽

Tanis C. Dingle ◽

Camille L. Hamula

Keyword(s):

Blood Culture ◽

Pediatric Patients ◽

Maldi Tof Ms ◽

Maldi Tof ◽

Antimicrobial Management ◽

Culture Identification ◽

The Impact ◽

Tof Ms

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Faculty Opinions recommendation of Clinical evaluation of the FilmArray blood culture identification panel in identification of bacteria and yeasts from positive blood culture bottles.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718131495.793498601 ◽

2014 ◽

Author(s):

Stan Deresinski

Keyword(s):

Blood Culture ◽

Clinical Evaluation ◽

Positive Blood Culture ◽

Identification Of Bacteria ◽

Culture Identification

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Risk factors and clinical outcomes associated with blood culture contamination

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.111 ◽

2021 ◽

pp. 1-7

Author(s):

Justin M. Klucher ◽

Kevin Davis ◽

Mrinmayee Lakkad ◽

Jacob T. Painter ◽

Ryan K. Dare

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Blood Culture ◽

Hospital Mortality ◽

Clinical Outcomes ◽

Tertiary Care ◽

Blood Cultures ◽

Hospital Charges ◽

Patient Specific ◽

Contaminated Blood

Abstract Objective: To determine patient-specific risk factors and clinical outcomes associated with contaminated blood cultures. Design: A single-center, retrospective case-control risk factor and clinical outcome analysis performed on inpatients with blood cultures collected in the emergency department, 2014–2018. Patients with contaminated blood cultures (cases) were compared to patients with negative blood cultures (controls). Setting: A 509-bed tertiary-care university hospital. Methods: Risk factors independently associated with blood-culture contamination were determined using multivariable logistic regression. The impacts of contamination on clinical outcomes were assessed using linear regression, logistic regression, and generalized linear model with γ log link. Results: Of 13,782 blood cultures, 1,504 (10.9%) true positives were excluded, leaving 1,012 (7.3%) cases and 11,266 (81.7%) controls. The following factors were independently associated with blood-culture contamination: increasing age (adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 1.01–1.01), black race (aOR, 1.32; 95% CI, 1.15–1.51), increased body mass index (BMI; aOR, 1.01; 95% CI, 1.00–1.02), chronic obstructive pulmonary disease (aOR, 1.16; 95% CI, 1.02–1.33), paralysis (aOR 1.64; 95% CI, 1.26–2.14) and sepsis plus shock (aOR, 1.26; 95% CI, 1.07–1.49). After controlling for age, race, BMI, and sepsis, blood-culture contamination increased length of stay (LOS; β = 1.24 ± 0.24; P < .0001), length of antibiotic treatment (LOT; β = 1.01 ± 0.20; P < .001), hospital charges (β = 0.22 ± 0.03; P < .0001), acute kidney injury (AKI; aOR, 1.60; 95% CI, 1.40–1.83), echocardiogram orders (aOR, 1.51; 95% CI, 1.30–1.75) and in-hospital mortality (aOR, 1.69; 95% CI, 1.31–2.16). Conclusions: These unique risk factors identify high-risk individuals for blood-culture contamination. After controlling for confounders, contamination significantly increased LOS, LOT, hospital charges, AKI, echocardiograms, and in-hospital mortality.

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Evaluation of the BioFire® FilmArray® Blood Culture Identification Panel on positive blood cultures in a regional hospital laboratory in KwaZulu-Natal

African Journal of Laboratory Medicine ◽

10.4102/ajlm.v5i1.411 ◽

2016 ◽

Vol 5 (1) ◽

Cited By ~ 4

Author(s):

Mokshanand Fhooblall ◽

Fikile Nkwanyana ◽

Koleka P. Mlisana

Keyword(s):

Blood Culture ◽

Antimicrobial Susceptibility ◽

Reference Method ◽

Blood Cultures ◽

Combination Methods ◽

Single Organism ◽

Hospitalised Patients ◽

Short Run ◽

Culture Identification ◽

Study Laboratory

Background: There are presently many non-culture-based methods commercially available to identify organisms and antimicrobial susceptibility from blood culture bottles. Each platform has its benefits and limitations. However, there is a need for an improved system with minimal hands-on requirements and short run times.Objectives: In this study, the performance characteristics of the FilmArray® BCID Panel kit were evaluated to assess the efficiency of the kit against an existing system used for identification and antimicrobial susceptibility of organisms from blood cultures.Methods: Positive blood cultures that had initially been received from hospitalised patients of a large quaternary referral hospital in Durban, South Africa were processed as per routine protocol at its Medical Microbiology Laboratory. Positive blood cultures were processed on the FilmArray BCID Panel kit in parallel with the routine sample processing. Inferences were then drawn from results obtained.Results: Organism detection by the FilmArray BCID panel was accurate at 92.6% when organisms that were on the repertoire of the kit were considered, compared to the combination methods (reference method used in the study laboratory). Detection of the antimicrobial resistance markers provided by the panel and reference method demonstrated 100% consistency. Blood cultures with a single organism were accurately identified at 93.8% by FilmArray, while blood cultures with more than one organism were identified at 85.7%.Conclusion: The FilmArray BCID Panel kit is valuable for detection of organisms and markers of antibiotic resistance for an extensive range of organisms.

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