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. 2025 Jan 21:14:1513408.
doi: 10.3389/fcimb.2024.1513408. eCollection 2024.

Rapid diagnostic testing combined with an immediate infectious disease consultation increases the rate of septic intensive care unit patients on targeted antibiotic therapy

Evelyn Kramme #  1 , Nadja Käding #  2   3 , Tobias Graf  4 , Karolin Schmoll  4 , Heidi Linnen  5 , Katharina Nagel  2 , Esther Grote-Levi  2 , Susanne Hauswaldt  2 , Dennis Nurjadi  2   3 , Jan Rupp  1   2   3
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Rapid diagnostic testing combined with an immediate infectious disease consultation increases the rate of septic intensive care unit patients on targeted antibiotic therapy

Evelyn Kramme et al. Front Cell Infect Microbiol. .

Abstract

Objectives: To evaluate the impact of rapid diagnostic testing (RDT) combined with immediate infectious disease (ID) consultation on the treatment of septic patients with positive blood cultures in intensive care units in a setting without 24/7 service.

Methods: Adult ICU patients in a tertiary care hospital with positive blood cultures were included from January 2019 to December 2020. The control group underwent routine laboratory testing, and for the intervention group, RDT was applied with immediate ID consultation.

Results: In 77 out of the 91 patients in the intervention group, the pathogen was identified by RDT. Regarding antimicrobial susceptibility testing (AST), genotypic testing (ePlex®) was successful for Gram-positive cocci, but inadequate for Gram-negative rods. Phenotypic resistance testing with the Accelerate PhenoTest® took too long to be successfully integrated into the intervention. Adaptation of empirical antibiotic therapy was recommended for 72.7% of the patients. Adherence to the ID consultation post-RDT results was high at 82.3%. In the control group, adaptation of the initial antibiotic therapy would have been recommended for 81.8% of patients, if the species identification had been available. Overall adherence to the local antibiotic therapy guideline for sepsis was significantly lower in the control than in the intervention group (27.8% versus 89.3%, p<0.001).

Conclusion: Integration of an RDT system in the microbiological workflow for septic patients in ICU combined with a standardized ID intervention led to a significantly higher percentage of adequate antimicrobial treatment and greater adherence to local antibiotic therapy recommendations, even in a setting where 24/7 service is not available.

Keywords: adequate antibiotic therapy; antimicrobial stewardship (AMS); blood stream infection (BSI); infectious diseases consultation; rapid diagnostic testing; sepsis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Overview of study design. Comparison of rapid diagnostic testing (RDT) using ePlex® (RDT1) and Accelerate® (RDT2) on the time to effective therapy as defined by the pathogen spectrum covered by the initial antibiotic therapy. (Figure created with Biorender.
See this image and copyright information in PMC

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