Susceptibility Provision Enhances Effective De-escalation (SPEED): utilizing rapid phenotypic susceptibility testing in Gram-negative bloodstream infections and its potential clinical impact

Jack G. Schneider, James B. Wood, Bryan Schmitt, Christopher Emery, Thomas Davis, Nathan W. Smith, Sarah Blevins, Jon Hiles, Armisha Desai, Justin Wrin, Brittany Bocian, John J. Manaloor

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: We evaluated the performance and time to result for pathogen identification (ID) and antimicrobial susceptibility testing (AST) of the Accelerate Pheno™ system (AXDX) compared with standard of care (SOC) methods. We also assessed the hypothetical improvement in antibiotic utilization if AXDX had been implemented. Methods: Clinical samples from patients with monomicrobial Gram-negative bacteraemia were tested and compared between AXDX and the SOC methods of the VERIGENE® and Bruker MALDI Biotyper® systems for ID and the VITEK® 2 system for AST. Additionally, charts were reviewed to calculate theoretical times to antibiotic de-escalation, escalation and active and optimal therapy. Results: ID mean time was 21 h for MALDI-TOF MS, 4.4 h for VERIGENE® and 3.7 h for AXDX. AST mean time was 35 h for VITEK® 2 and 9.0 h for AXDX. For ID, positive percentage agreement was 95.9% and negative percentage agreement was 99.9%. For AST, essential agreement was 94.5% and categorical agreement was 93.5%. If AXDX results had been available to inform patient care, 25% of patients could have been put on active therapy sooner, while 78% of patients who had therapy optimized during hospitalization could have had therapy optimized sooner. Additionally, AXDX could have reduced time to de-escalation (16 versus 31 h) and escalation (19 versus 31 h) compared with SOC. Conclusions: By providing fast and reliable ID and AST results, AXDX has the potential to improve antimicrobial utilization and enhance antimicrobial stewardship.

Original languageEnglish (US)
Pages (from-to)i16-i23
JournalThe Journal of antimicrobial chemotherapy
Volume74
Issue number1
DOIs
StatePublished - Jan 1 2019

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Standard of Care
Infection
Matrix-Assisted Laser Desorption-Ionization Mass Spectrometry
Anti-Bacterial Agents
Therapeutics
Bacteremia
Patient Care
Hospitalization

ASJC Scopus subject areas

  • Pharmacology
  • Microbiology (medical)
  • Pharmacology (medical)
  • Infectious Diseases

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Susceptibility Provision Enhances Effective De-escalation (SPEED) : utilizing rapid phenotypic susceptibility testing in Gram-negative bloodstream infections and its potential clinical impact. / Schneider, Jack G.; Wood, James B.; Schmitt, Bryan; Emery, Christopher; Davis, Thomas; Smith, Nathan W.; Blevins, Sarah; Hiles, Jon; Desai, Armisha; Wrin, Justin; Bocian, Brittany; Manaloor, John J.

In: The Journal of antimicrobial chemotherapy, Vol. 74, No. 1, 01.01.2019, p. i16-i23.

Research output: Contribution to journalArticle

Schneider, Jack G. ; Wood, James B. ; Schmitt, Bryan ; Emery, Christopher ; Davis, Thomas ; Smith, Nathan W. ; Blevins, Sarah ; Hiles, Jon ; Desai, Armisha ; Wrin, Justin ; Bocian, Brittany ; Manaloor, John J. / Susceptibility Provision Enhances Effective De-escalation (SPEED) : utilizing rapid phenotypic susceptibility testing in Gram-negative bloodstream infections and its potential clinical impact. In: The Journal of antimicrobial chemotherapy. 2019 ; Vol. 74, No. 1. pp. i16-i23.
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T2 - utilizing rapid phenotypic susceptibility testing in Gram-negative bloodstream infections and its potential clinical impact

AU - Schneider, Jack G.

AU - Wood, James B.

AU - Schmitt, Bryan

AU - Emery, Christopher

AU - Davis, Thomas

AU - Smith, Nathan W.

AU - Blevins, Sarah

AU - Hiles, Jon

AU - Desai, Armisha

AU - Wrin, Justin

AU - Bocian, Brittany

AU - Manaloor, John J.

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N2 - Objectives: We evaluated the performance and time to result for pathogen identification (ID) and antimicrobial susceptibility testing (AST) of the Accelerate Pheno™ system (AXDX) compared with standard of care (SOC) methods. We also assessed the hypothetical improvement in antibiotic utilization if AXDX had been implemented. Methods: Clinical samples from patients with monomicrobial Gram-negative bacteraemia were tested and compared between AXDX and the SOC methods of the VERIGENE® and Bruker MALDI Biotyper® systems for ID and the VITEK® 2 system for AST. Additionally, charts were reviewed to calculate theoretical times to antibiotic de-escalation, escalation and active and optimal therapy. Results: ID mean time was 21 h for MALDI-TOF MS, 4.4 h for VERIGENE® and 3.7 h for AXDX. AST mean time was 35 h for VITEK® 2 and 9.0 h for AXDX. For ID, positive percentage agreement was 95.9% and negative percentage agreement was 99.9%. For AST, essential agreement was 94.5% and categorical agreement was 93.5%. If AXDX results had been available to inform patient care, 25% of patients could have been put on active therapy sooner, while 78% of patients who had therapy optimized during hospitalization could have had therapy optimized sooner. Additionally, AXDX could have reduced time to de-escalation (16 versus 31 h) and escalation (19 versus 31 h) compared with SOC. Conclusions: By providing fast and reliable ID and AST results, AXDX has the potential to improve antimicrobial utilization and enhance antimicrobial stewardship.

AB - Objectives: We evaluated the performance and time to result for pathogen identification (ID) and antimicrobial susceptibility testing (AST) of the Accelerate Pheno™ system (AXDX) compared with standard of care (SOC) methods. We also assessed the hypothetical improvement in antibiotic utilization if AXDX had been implemented. Methods: Clinical samples from patients with monomicrobial Gram-negative bacteraemia were tested and compared between AXDX and the SOC methods of the VERIGENE® and Bruker MALDI Biotyper® systems for ID and the VITEK® 2 system for AST. Additionally, charts were reviewed to calculate theoretical times to antibiotic de-escalation, escalation and active and optimal therapy. Results: ID mean time was 21 h for MALDI-TOF MS, 4.4 h for VERIGENE® and 3.7 h for AXDX. AST mean time was 35 h for VITEK® 2 and 9.0 h for AXDX. For ID, positive percentage agreement was 95.9% and negative percentage agreement was 99.9%. For AST, essential agreement was 94.5% and categorical agreement was 93.5%. If AXDX results had been available to inform patient care, 25% of patients could have been put on active therapy sooner, while 78% of patients who had therapy optimized during hospitalization could have had therapy optimized sooner. Additionally, AXDX could have reduced time to de-escalation (16 versus 31 h) and escalation (19 versus 31 h) compared with SOC. Conclusions: By providing fast and reliable ID and AST results, AXDX has the potential to improve antimicrobial utilization and enhance antimicrobial stewardship.

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