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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. | LitMetric

AI Article Synopsis

  • The study compared the performance and timing of the Accelerate Pheno™ system (AXDX) for identifying pathogens and testing their susceptibility to antibiotics against standard methods like VERIGENE® and Bruker MALDI Biotyper® for identification and VITEK® 2 for susceptibility.
  • AXDX delivered faster results, with pathogen identification taking about 3.7 hours and antimicrobial susceptibility testing taking 9 hours, significantly quicker than standard methods.
  • Implementing AXDX could lead to improved antibiotic usage, with quicker adjustments to patient therapy—25% of patients could start effective treatment sooner, and overall optimization times during hospitalization could also decrease.

Article 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.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382035PMC
http://dx.doi.org/10.1093/jac/dky531DOI Listing

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