Impact of rapid diagnosis of Staphylococcus aureus bacteremia from positive blood cultures on patient management

• Published in: European journal of clinical microbiology & infectious diseases 2017-12, Vol.36 (12), p.2469-2473
• Main Authors: Romero-Gómez, M. P., Cendejas-Bueno, E., García Rodriguez, J., Mingorance, J.
• Format: Article
• Language: English
• Subjects: Adequacy; Adult; Aged; Aged, 80 and over; Antiinfectives and antibacterials; Bacteremia; Bacteriological Techniques; Biomedical and Life Sciences; Biomedicine; Blood; Blood Culture; Desorption; Diagnosis; Drug resistance; Female; Humans; Identification methods; Internal Medicine; Ionization; Ions; Lasers; Length of Stay; Male; Medical Microbiology; Methicillin; Middle Aged; Original Article; Polymerase chain reaction; Polymerase Chain Reaction - methods; Retrospective Studies; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization - methods; Staphylococcal Infections - diagnosis; Staphylococcal Infections - microbiology; Staphylococcal Infections - therapy; Staphylococcus aureus; Staphylococcus aureus - classification; Staphylococcus aureus - genetics; Staphylococcus infections; Therapy
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-017-3086-5

We have performed a retrospective, before–after comparison of turnaround time and therapy adjustment parameters before and after the introduction of matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) plus mecA polymerase chain reaction (PCR) for the identification of methicillin-resistant Staphylococcus aureus (MRSA) in positive blood cultures. There were 227 episodes of S. aureus bacteremia during the study periods. The pre-MALDI-TOF and post-MALDI-TOF groups included 133 and 94 patients, respectively. The two rapid methods performed sequentially decreased the turnaround time of MRSA identification by nearly 50% (2.06 ± 1.95 vs. 3.95 ± 1.70 days). There was no significant reduction in the length of hospitalization (28.27 ± 32.16 vs. 28.62 ± 28.75 days). In both groups, the adequacy of the empirical antibacterial therapy was similar (59.49% vs. 51.31%), but the optimization of the therapy was more frequent in the post-MALDI-TOF group. Routine implementation of these techniques provides results earlier than conventional methods and increases the proportion of episodes with adequate change of empirical to directed antimicrobial therapy.