Impact of rapid identification of positive blood cultures using the Verigene system on antibiotic prescriptions: A prospective study of community-onset bacteremia in a tertiary hospital in Japan

• Published in: PloS one 2017-07, Vol.12 (7), p.e0181548-e0181548
• Main Authors: Hayakawa, Kayoko, Mezaki, Kazuhisa, Kobayakawa, Masao, Yamamoto, Kei, Mutoh, Yoshikazu, Tsuboi, Motoyuki, Hasimoto, Takehiro, Nagamatsu, Maki, Kutsuna, Satoshi, Takeshita, Nozomi, Katanami, Yuichi, Ishikane, Masahiro, Ohmagari, Norio
• Format: Article
• Language: English
• Subjects: Acquisitions & mergers; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antiinfectives and antibacterials; Antimicrobial resistance; Automation; Bacteremia; Bacteremia - blood; Bacteremia - drug therapy; Bacteremia - epidemiology; Bacteria; Biology and Life Sciences; Blood; Blood culture; Blood Culture - economics; Blood Culture - methods; Communities; Diagnosis; Disease control; Disease prevention; Distribution; Drug therapy; E coli; Epidemiology; Female; Gram-negative bacteria; Gram-Negative Bacteria - drug effects; Gram-Negative Bacteria - isolation & purification; Gram-positive bacteria; Gram-Positive Bacteria - drug effects; Gram-Positive Bacteria - isolation & purification; Hospitals; Humans; Identification; Infectious diseases; Japan - epidemiology; Laboratories; Male; Medicine; Medicine and Health Sciences; Middle Aged; Pathogens; Patients; Prescriptions; Prescriptions (Drugs); Prospective Studies; Software; Staphylococcus infections; Tertiary Care Centers
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0181548

Rapid identification of positive blood cultures is important for initiation of optimal treatment in septic patients. Effects of automated, microarray-based rapid identification systems on antibiotic prescription against community-onset bacteremia (COB) remain unclear. We prospectively enrolled 177 patients with 185 COB episodes (occurring within 72 h of admission) over 17 months. Bacteremia episodes due to gram-positive bacteria (GP) and gram-negative bacteria (GN) in the same patient were counted separately. For GP bacteremia, patients with ≥2 sets of positive blood cultures were included. The primary study objective was evaluating the rates of antibiotic prescription changes within 2 days of rapid identification using the Verigene system. Bacteremia due to GN and GP included 144/185 (77.8%) and 41/185 (22.2%) episodes, respectively. Antibiotic prescription changes occurred in 51/185 cases (27.6% [95%CI:21.3-34.6%]) after Verigene analysis and 70/185 cases (37.8% [30.8-45.2%]) after conventional identification and susceptibility testing. Prescription changes after Verigene identification were more frequent in GP (17/41[41.5%]) than in GN (34/144[23.5%]). Among bacteremia due to single pathogen targeted by Verigene test, bacterial identification agreement between the two tests was high (GP: 38/39[97.4%], GN: 116/116[100%]). The Verigene test correctly predicted targeted antimicrobial resistance. The durations between the initiation of incubation and reporting of the results for the Verigene system and conventional test was 28.3 h (IQR: 25.8-43.4 h) and 90.6 h (68.3-118.4 h), respectively. In only four of the seven episodes of COB in which two isolates were identified by conventional tests, the Verigene test correctly identified both organisms. We observed a high rate of antibiotic prescription changes after the Verigene test in a population with COB especially in GP. The Verigene test would be a useful tool in antimicrobial stewardship programs among patients with COB.