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. 2023 Jul 29;22(1):62.
doi: 10.1186/s12941-023-00619-6.

Clinical impact of the accelerate PhenoTest® BC system on patients with gram-negative bacteremia and high risk of antimicrobial resistance: a prospective before-after implementation study

Tal Brosh-Nissimov  1   2 , Anka Tzur  3 , Daniel Grupel  3   4 , Amos Cahan  3 , Nir Ma'aravi  3 , Maya Heled-Akiva  3 , Hasan Jawamis  3 , Hanna Leskes  3 , Erez Barenboim  3 , Nadav Sorek  3
Affiliations

Clinical impact of the accelerate PhenoTest® BC system on patients with gram-negative bacteremia and high risk of antimicrobial resistance: a prospective before-after implementation study

Tal Brosh-Nissimov et al. Ann Clin Microbiol Antimicrob. .

Abstract

Background: The Accelerate PhenoTest® BC system (AXDX) is a novel assay for rapid bacterial identification and antimicrobial susceptibility (AST). We report an evaluation of its impact on treatment of patients with Gram-negative bacteremia (GNB) with a high risk of antimicrobial resistance (AMR).

Methods: A prospective single-center evaluation before and after implementation of AXDX in addition to standard-of-care (SOC) microbiology and antimicrobial stewardship program (ASP). Patients with GNB reported during laboratory working hours and prespecified risk factors for AMR were included. The primary outcome was an ASP-oriented beneficial antimicrobial change, defined as either an escalation of an inappropriate empiric treatment or de-escalation of a broad-spectrum treatment of a susceptible organism. Main secondary outcomes were time to an appropriate treatment, antimicrobial treatment duration, length of stay (LOS) and mortality.

Results: Included were 46 and 57 patients in the pre- and post-intervention periods, respectively. The median time to an AST-oriented beneficial change was 29.2 h vs. 49.6 h, respectively (p < 0.0001). There were no significant differences in the time to appropriate treatment, LOS or mortality. Antimicrobial treatment duration was longer during the intervention period (10 vs. 8 days, p = 0.007). AXDX failed to correctly identify pathogens in all 6 cases of polymicrobial bacteremia. In two cases patient care was potentially compromised due to inappropriate de-escalation.

Conclusions: AXDX implementation resulted in a 20.4-hour shorter time to an ASP-oriented beneficial antimicrobial change. This should be weighed against the higher costs, the lack of other proven clinical benefits and the potential harm from mis-identification of polymicrobial bacteremias.

Keywords: Antibiotic stewardship; Antimicrobial susceptibility testing; Antimicrobial treatment; Gram negative bacteremia; Rapid AST; Rapid identification.

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Conflict of interest statement

TBN received speaker and/or consultant honoraria from AstraZeneca, MSD, Pfizer, and Reckitt Banckizer.

Figures

Fig. 1
Fig. 1
Flowchart of study population
Fig. 2
Fig. 2
(a) Percentage of patients with a beneficial change according to time from blood culture sampling. (b) Percentage of patients receiving appropriate antimicrobials according to time from blood culture sampling
See this image and copyright information in PMC

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