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. 2015 Mar;59(3):1588-95.
doi: 10.1128/AAC.04259-14. Epub 2014 Dec 29.

Rapid testing using the Verigene Gram-negative blood culture nucleic acid test in combination with antimicrobial stewardship intervention against Gram-negative bacteremia

Jacqueline T Bork  1 , Surbhi Leekha  2 , Emily L Heil  3 , LiCheng Zhao  4 , Rilwan Badamas  5 , J Kristie Johnson  6
Affiliations

Rapid testing using the Verigene Gram-negative blood culture nucleic acid test in combination with antimicrobial stewardship intervention against Gram-negative bacteremia

Jacqueline T Bork et al. Antimicrob Agents Chemother. 2015 Mar.

Abstract

Rapid identification of microorganisms and antimicrobial resistance is paramount for targeted treatment in serious bloodstream infections (BSI). The Verigene Gram-negative blood culture nucleic acid test (BC-GN) is a multiplex, automated molecular diagnostic test for identification of eight Gram-negative (GN) organisms and resistance markers from blood culture with a turnaround time of approximately 2 h. Clinical isolates from adult patients at the University Maryland Medical Center with GN bacteremia from 1 January 2012 to 30 June 2012 were included in this study. Blood culture bottles were spiked with clinical isolates, allowed to incubate, and processed by BC-GN. A diagnostic evaluation was performed. In addition, a theoretical evaluation of time to effective and optimal antibiotic was performed, comparing actual antibiotic administration times from chart review ("control") to theoretical administration times based on BC-GN reporting and antimicrobial stewardship team (AST) review ("intervention"). For organisms detected by the assay, BC-GN correctly identified 95.6% (131/137), with a sensitivity of 97.1% (95% confidence interval [CI], 90.7 to 98.4%) and a specificity of 99.5% (95% CI, 98.8 to 99.8%). CTX-M and OXA resistance determinants were both detected. Allowing 12 h from Gram stain for antibiotic implementation, the intervention group had a significantly shorter duration to both effective (3.3 versus 7.0 h; P < 0.01) and optimal (23.5 versus 41.8 h; P < 0.01) antibiotic therapy. BC-GN with AST intervention can potentially decrease time to both effective and optimal antibiotic therapy in GN BSI.

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Figures

FIG 1
FIG 1
Selection of patients. NLFGNR, non-lactose-fermenting Gram-negative rod; GS, Gram stain; GNR, Gram-negative rod.
FIG 2
FIG 2
Days of therapy (DOT) per 1,000 patient days from the Gram stain report until 24 h after the susceptibility report. Dark gray bars, control; light gray bars, intervention. For the intervention group, the antibiotic is considered to be administered 3 h from the Gram stain report. Abbreviations: CTX, ceftriaxone; FEP, cefepime; TZP, piperacillin-tazobactam; CBP, carbapenem.
FIG 3
FIG 3
Timeline of events (hours). Abbreviations: GS, Gram stain; ID, identification.
See this image and copyright information in PMC

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