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. 2024 Aug 16;79(2):502-515.
doi: 10.1093/cid/ciae234.

Rapid Diagnostic Tests and Antimicrobial Stewardship Programs for the Management of Bloodstream Infection: What Is Their Relative Contribution to Improving Clinical Outcomes? A Systematic Review and Network Meta-analysis

Anna Maria Peri  1 , Mark D Chatfield  1 , Weiping Ling  1 , Luis Furuya-Kanamori  1 , Patrick N A Harris  1   2   3 , David L Paterson  1   4   5
Affiliations

Rapid Diagnostic Tests and Antimicrobial Stewardship Programs for the Management of Bloodstream Infection: What Is Their Relative Contribution to Improving Clinical Outcomes? A Systematic Review and Network Meta-analysis

Anna Maria Peri et al. Clin Infect Dis. .

Abstract

Background: Evidence about the clinical impact of rapid diagnostic tests (RDTs) for the diagnosis of bloodstream infections is limited, and whether RDT are superior to conventional blood cultures (BCs) embedded within antimicrobial stewardship programs (ASPs) is unknown.

Methods: We performed network meta-analyses using results from studies of patients with bloodstream infection with the aim of comparing the clinical impact of RDT (applied on positive BC broth or whole blood) to conventional BC, both assessed with and without ASP with respect to mortality, length of stay (LOS), and time to optimal therapy.

Results: Eighty-eight papers were selected, including 25 682 patient encounters. There was an appreciable amount of statistical heterogeneity within each meta-analysis. The network meta-analyses showed a significant reduction in mortality associated with the use of RDT + ASP versus BC alone (odds ratio [OR], 0.72; 95% confidence interval [CI], .59-.87) and with the use of RDT + ASP versus BC + ASP (OR, 0.78; 95% CI, .63-.96). No benefit in survival was found associated with the use of RDT alone nor with BC + ASP compared to BC alone. A reduction in LOS was associated with RDT + ASP versus BC alone (OR, 0.91; 95% CI, .84-.98) whereas no difference in LOS was shown between any other groups. A reduced time to optimal therapy was shown when RDT + ASP was compared to BC alone (-29 hours; 95% CI, -35 to -23), BC + ASP (-18 hours; 95% CI, -27 to -10), and to RDT alone (-12 hours; 95% CI, -20 to -3).

Conclusions: The use of RDT + ASP may lead to a survival benefit even when introduced in settings already adopting effective ASP in association with conventional BC.

Keywords: antimicrobial stewardship; blood culture; bloodstream infection; network meta-analysis; rapid diagnostic tests.

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Conflict of interest statement

Potential conflicts of interest . D. L. P. has research funding from Shionogi, Merck, bioMerieux, BioVersys, and Pfizer and has received consulting fees from the AMR Action Fund, CARB-X, Aurobac, Pfizer, Merck, Cepheid, bioMérieux, and Spero. P. N. A. H. reports research grants from Gilead, has served on advisory boards for OpGen, Merck, and Sandoz, and has received honoraria from OpGen, Sandoz, Pfizer, and bioMerieux. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Network plot reporting the number of studies assessing each of the comparisons included in the NMA. It was expected that a paucity of studies would be found comparing BC + ASP to RDT alone as in the common context of a pre/postinterventional study, the implementation of RDT in a setting already using ASP with conventional BC would unlikely involve ceasing the use of ASP. Abbreviations: ASP, antimicrobial stewardship program; BC, blood culture; NMA, network meta-analysis; RDT, rapid diagnostic test.
Figure 2.
Figure 2.
PRISMA flow diagram for studies selection. *Studies coincided with reports.
Figure 3.
Figure 3.
Estimates, 95% confidence intervals and 95% prediction intervals for (A) TOT, (B) LOS, (C) mortality. Abbreviations: ASP, antimicrobial stewardship program; BC, blood culture; CI, confidence interval; LOS, length of stay; PI, prediction interval; RDT, rapid diagnostic test; TOT, time to optimal therapy.
See this image and copyright information in PMC

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