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European Journal of Clinical Microbiology & Infectious Diseases

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06.09.2024 | Research

The impact of optimizing microbial diagnosis processes on clinical and healthcare economic outcomes in hospitalized patients with bloodstream infections

verfasst von: Genwei Ai, Ying Zhang, Kunshan Guo, Lu Zhao, Zhi Li, He Hai, Erjuan Jia, Junying Liu

Erschienen in: European Journal of Clinical Microbiology & Infectious Diseases | Ausgabe 11/2024

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Abstract

Purpose

Bloodstream infections (BSIs) are associated with significant morbidity, mortality and costs, while prolonged blood culture (BC) diagnosis may delay the initiation of targeted therapy. This study evaluates the impact of an optimized microbiology laboratory process on turnaround times, antibiotic use, clinical outcomes and economics for hospitalized BSI patients.

Methods

A pre-post study was conducted in a Chinese hospital in which BSI derived BC results before (Oct. 2020- Sep. 2021) and after (Oct. 2021- Sep. 2022) newly implemented microbiology diagnostics and workflow changes were analyzed. Turnaround times, antibiotic initiation, length of stay and in-hospital costs were compared.

Results

From 213 included patients, 134 were pre-optimization (pre-op) and 79 were post-optimization (post-op) cases. The median time from blood sample collection (BSC) to pathogen identification (ID) decreased from 70.12 to 47.43 h post-op (P < 0.001). The median time from BSC to the first ID report related initiation of pathogen-directed antibiotic use decreased from 88.48 to 47.85 h post-op (P < 0.001). The average hospital stay decreased from 19.54 to 16.79 days and 30-day readmissions declined from 18.7 to 13.9%, while the mean total antimicrobial drug usage costs decreased by 3,889 CNY per patient (P = 0.022) after optimization.

Conclusions

Implementing new diagnostics technologies and optimizing laboratory workflows significantly reduced antimicrobial drug usage costs, shortened the time to ID results and improved the timeliness of appropriate antibiotic choices to treat BSIs. Investments in faster testing and process improvements were clearly beneficial for patient outcomes and healthcare economics.

Nur mit Berechtigung zugänglich

Kern WV, Rieg S (2020) Burden of bacterial bloodstream infection-a brief update on epidemiology and significance of multidrug-resistant pathogens. Clin Microbiol Infect 26:151–157. https://doi.org/10.1016/j.cmi.2019.10.031CrossRefPubMed

Liu BM, Carlisle CP, Fisher MA, Shakir SM (2021) The brief case: Capnocytophaga sputigena bacteremia in a 94-year-old male with type 2 diabetes mellitus, pancytopenia, and bronchopneumonia. J Clin Microbiol 59:e0247220. https://doi.org/10.1128/jcm.02472-20CrossRefPubMed

Zhang Y, Du M, Johnston JM et al (2020) Estimating length of stay and inpatient charges attributable to hospital-acquired bloodstream infections. Antimicrob Resist Infect Control 9:137. https://doi.org/10.1186/s13756-020-00796-5CrossRefPubMedPubMedCentral

Gidey K, Gidey MT, Hailu BY, Gebreamlak ZB, Niriayo YL (2023) Clinical and economic burden of healthcare-associated infections: a prospective cohort study. PLoS ONE 18:e0282141. https://doi.org/10.1371/journal.pone.0282141CrossRefPubMedPubMedCentral

Verway M, Brown KA, Marchand-Austin A et al (2022) Prevalence and mortality associated with bloodstream organisms: a population-wide retrospective cohort study. J Clin Microbiol 60:e0242921. https://doi.org/10.1128/jcm.02429-21CrossRefPubMed

Briggs N, Campbell S, Gupta S (2021) Advances in rapid diagnostics for bloodstream infections. Diagn Microbiol Infect Dis 99:115219. https://doi.org/10.1016/j.diagmicrobio.2020.115219CrossRefPubMed

Fleming-Dutra KE, Hersh AL, Shapiro DJ et al (2016) Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA 315:1864–1873. https://doi.org/10.1001/jama.2016.4151CrossRefPubMed

Zhao H, Wei L, Li H et al (2021) Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study. Lancet Infect Dis 21:847–857. https://doi.org/10.1016/s1473-3099(20)30596-xCrossRefPubMed

Pohl D, Keller PM, Bordier V, Wagner K (2019) Review of current diagnostic methods and advances in Helicobacter pylori diagnostics in the era of next generation sequencing. World J Gastroenterol 25:4629–4660. https://doi.org/10.3748/wjg.v25.i32.4629CrossRefPubMedPubMedCentral

10.

Elbehiry A, Aldubaib M, Abalkhail A et al (2022) How MALDI-TOF mass spectrometry technology contributes to microbial infection control in healthcare settings. Vaccines (Basel) 10. https://doi.org/10.3390/vaccines10111881

11.

Liu BM, Beck EM, Fisher MA (2021) The brief case: ventilator-associated corynebacterium accolens pneumonia in a patient with respiratory failure due to COVID-19. J Clin Microbiol 59:e0013721. https://doi.org/10.1128/jcm.00137-21CrossRefPubMed

12.

Peng Y, Liu B, Hou J et al (2015) Naturally occurring deletions/insertions in HBV core promoter tend to decrease in hepatitis B e antigen-positive chronic hepatitis B patients during antiviral therapy. Antivir Ther 20:623–632. https://doi.org/10.3851/imp2955CrossRefPubMed

13.

Liu B, Yang JX, Yan L, Zhuang H, Li T (2018) Novel HBV recombinants between genotypes B and C in 3’-terminal reverse transcriptase (RT) sequences are associated with enhanced viral DNA load, higher RT point mutation rates and place of birth among Chinese patients. Infect Genet Evol 57:26–35. https://doi.org/10.1016/j.meegid.2017.10.023CrossRefPubMed

14.

Liu BM, Rakhmanina NY, Yang Z, Bukrinsky MI (2024) Mpox (Monkeypox) virus and its co-infection with HIV, sexually transmitted infections, or bacterial superinfections: Double whammy or a new prime culprit? Viruses 16. https://doi.org/10.3390/v16050784

15.

Liu B, Forman M, Valsamakis A (2019) Optimization and evaluation of a novel real-time RT-PCR test for detection of parechovirus in cerebrospinal fluid. J Virol Methods 272:113690. https://doi.org/10.1016/j.jviromet.2019.113690CrossRefPubMed

16.

Liu BM, Hill HR (2020) Role of host immune and inflammatory responses in COVID-19 cases with underlying primary immunodeficiency: a review. J Interferon Cytokine Res 40:549–554. https://doi.org/10.1089/jir.2020.0210CrossRefPubMedPubMedCentral

17.

Koizumi Y, Sakanashi D, Ohno T et al (2019) The clinical characteristics of Acinetobacter bacteremia differ among genomospecies: a hospital-based retrospective comparative analysis of genotypically identified strains. J Microbiol Immunol Infect 52:966–972. https://doi.org/10.1016/j.jmii.2019.09.007CrossRefPubMed

18.

Kang FY, How CK, Wang YC et al (2020) Influence of severity of infection on the effect of appropriate antimicrobial therapy for Acinetobacter baumannii bacteremic pneumonia. Antimicrob Resist Infect Control 9:160. https://doi.org/10.1186/s13756-020-00824-4CrossRefPubMedPubMedCentral

19.

Buehler SS, Madison B, Snyder SR et al (2016) Effectiveness of practices to increase timeliness of providing targeted therapy for inpatients with bloodstream infections: a laboratory medicine best practices systematic review and meta-analysis. Clin Microbiol Rev 29:59–103. https://doi.org/10.1128/cmr.00053-14CrossRefPubMed

20.

Charani E, Castro-Sanchez E, Sevdalis N et al (2013) Understanding the determinants of antimicrobial prescribing within hospitals: the role of prescribing etiquette. Clin Infect Dis 57:188–196. https://doi.org/10.1093/cid/cit212CrossRefPubMedPubMedCentral

21.

Chavada R, Walker HN, Tong D, Murray A (2017) Changes in antimicrobial prescribing behavior after the introduction of the antimicrobial stewardship program: a pre- and post-intervention survey. Infect Dis Rep 9:7268. https://doi.org/10.4081/idr.2017.7268CrossRefPubMedPubMedCentral

22.

Nasef R, El Lababidi R, Alatoom A, Krishnaprasad S, Bonilla F (2020) The impact of integrating rapid PCR-based blood culture identification panel to an established antimicrobial stewardship program in the United Arab of Emirates. Int J Infect Dis 91:124–128. https://doi.org/10.1016/j.ijid.2019.11.028CrossRefPubMed

23.

Hogan CA, Ebunji B, Watz N et al (2020) Impact of rapid antimicrobial susceptibility testing in Gram-negative rod bacteremia: a quasi-experimental study. J Clin Microbiol 58. https://doi.org/10.1128/jcm.00360-20

24.

Ehren K, Meißner A, Jazmati N et al (2020) Clinical impact of rapid species identification from positive blood cultures with same-day phenotypic antimicrobial susceptibility testing on the management and outcome of bloodstream infections. Clin Infect Dis 70:1285–1293. https://doi.org/10.1093/cid/ciz406CrossRefPubMed

25.

Stevenson LG, Drake SK, Murray PR (2010) Rapid identification of bacteria in positive blood culture broths by matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol 48:444–447. https://doi.org/10.1128/jcm.01541-09CrossRefPubMed

26.

Prod’hom G, Bizzini A, Durussel C, Bille J, Greub G (2010) Matrix-assisted laser desorption ionization-time of flight mass spectrometry for direct bacterial identification from positive blood culture pellets. J Clin Microbiol 48:1481–1483. https://doi.org/10.1128/jcm.01780-09CrossRefPubMedPubMedCentral

27.

Croxatto A, Prod’hom G, Greub G (2012) Applications of MALDI-TOF mass spectrometry in clinical diagnostic microbiology. FEMS Microbiol Rev 36:380–407. https://doi.org/10.1111/j.1574-6976.2011.00298.xCrossRefPubMed

28.

Drancourt M (2010) Detection of microorganisms in blood specimens using matrix-assisted laser desorption ionization time-of-flight mass spectrometry: a review. Clin Microbiol Infect 16:1620–1625. https://doi.org/10.1111/j.1469-0691.2010.03290.xCrossRefPubMed

29.

Vlek AL, Bonten MJ, Boel CH (2012) Direct matrix-assisted laser desorption ionization time-of-flight mass spectrometry improves appropriateness of antibiotic treatment of bacteremia. PLoS ONE 7:e32589. https://doi.org/10.1371/journal.pone.0032589CrossRefPubMedPubMedCentral

30.

Centers for Disease Control and Prevention (U.S.); National Center for Emerging Zoonotic and Infectious Diseases (U.S.). Division of Healthcare Quality Promotion. Antibiotic Resistance Coordination and Strategy Unit (2019) Antibiotic resistance threats in the United States, 2019. https://stacks.cdc.gov/view/cdc/82532. Accessed 21 June 2024

31.

Smith R, Coast J (2013) The true cost of antimicrobial resistance. BMJ 346:f1493. https://doi.org/10.1136/bmj.f1493CrossRefPubMed

32.

Chang CY, Schiano TD (2007) Review article: drug hepatotoxicity. Aliment Pharmacol Ther 25:1135–1151. https://doi.org/10.1111/j.1365-2036.2007.03307.xCrossRefPubMed

33.

Kollef MH (2008) Broad-spectrum antimicrobials and the treatment of serious bacterial infections: getting it right up front. Clin Infect Dis 47(Suppl 1):S3–13. https://doi.org/10.1086/590061CrossRefPubMed

34.

Benkova M, Soukup O, Marek J (2020) Antimicrobial susceptibility testing: currently used methods and devices and the near future in clinical practice. J Appl Microbiol 129:806–822. https://doi.org/10.1111/jam.14704CrossRefPubMed

35.

Adamik M, Hutchins A, Mangilit J, Katzin B, Totty H, Deol P (2021) Effect of delayed entry on performance of the BACT/ALERT FAN PLUS bottles in the BACT/ALERT VIRTUO blood culture system. Eur J Clin Microbiol Infect Dis 40:699–705. https://doi.org/10.1007/s10096-020-04042-zCrossRefPubMed

36.

Kirn TJ, Mirrett S, Reller LB, Weinstein MP (2014) Controlled clinical comparison of BacT/alert FA plus and FN plus blood culture media with BacT/alert FA and FN blood culture media. J Clin Microbiol 52:839–843. https://doi.org/10.1128/jcm.03063-13CrossRefPubMedPubMedCentral

37.

Giordano L, Liotti FM, Menchinelli G et al (2021) Simulated pediatric blood cultures to assess the inactivation of clinically relevant antimicrobial drug concentrations in resin-containing bottles. Front Cell Infect Microbiol 11:649769. https://doi.org/10.3389/fcimb.2021.649769CrossRefPubMedPubMedCentral

38.

Spaargaren J, van Boven CP, Voorn GP (1998) Effectiveness of resins in neutralizing antibiotic activities in bactec plus Aerobic/F culture medium. J Clin Microbiol 36:3731–3733. https://doi.org/10.1128/jcm.36.12.3731-3733.1998CrossRefPubMedPubMedCentral

39.

Dellit TH, Owens RC, McGowan JE Jr et al (2007) Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 44:159–177. https://doi.org/10.1086/510393CrossRefPubMed

40.

Habboush Y, Guzman N, StatPearls (2023) Jun Treasure Island (FL): StatPearls Publishing; 20

41.

Tacconelli E, Mazzaferri F, de Smet AM et al (2019) ESCMID-EUCIC clinical guidelines on decolonization of multidrug-resistant Gram-negative bacteria carriers. Clin Microbiol Infect 25:807–817. https://doi.org/10.1016/j.cmi.2019.01.005CrossRefPubMed

42.

Vink J, Edgeworth J, Bailey SL (2020) Acquisition of MDR-GNB in hospital settings: a systematic review and meta-analysis focusing on ESBL-E. J Hosp Infect 106:419–428. https://doi.org/10.1016/j.jhin.2020.09.006CrossRefPubMed

43.

Banerjee R, Teng CB, Cunningham SA et al (2015) Randomized trial of rapid multiplex polymerase chain reaction-based blood culture identification and susceptibility testing. Clin Infect Dis 61:1071–1080. https://doi.org/10.1093/cid/civ447CrossRefPubMedPubMedCentral

44.

Banerjee R, Komarow L, Virk A et al (2021) Randomized trial evaluating clinical impact of RAPid IDentification and susceptibility testing for Gram-negative bacteremia: RAPIDS-GN. Clin Infect Dis 73:e39–e46. https://doi.org/10.1093/cid/ciaa528CrossRefPubMed

45.

Timbrook TT, Morton JB, McConeghy KW, Caffrey AR, Mylonakis E, LaPlante KL (2017) The effect of molecular rapid diagnostic testing on clinical outcomes in bloodstream infections: a systematic review and meta-analysis. Clin Infect Dis 64:15–23. https://doi.org/10.1093/cid/ciw649CrossRefPubMed

46.

Kuwabara G, Yukawa S, Yamada K et al (2020) The effect of intervention by an antimicrobial stewardship team on anaerobic bacteremia. Anaerobe 64:102214. https://doi.org/10.1016/j.anaerobe.2020.102214CrossRefPubMed

47.

Pliakos EE, Andreatos N, Shehadeh F, Ziakas PD, Mylonakis E (2018) The cost-effectiveness of rapid diagnostic testing for the diagnosis of bloodstream infections with or without antimicrobial stewardship. Clin Microbiol Rev 31. https://doi.org/10.1128/cmr.00095-17

48.

Sakarikou C, Altieri A, Bossa MC et al (2018) Rapid and cost-effective identification and antimicrobial susceptibility testing in patients with Gram-negative bacteremia directly from blood-culture fluid. J Microbiol Methods 146:7–12. https://doi.org/10.1016/j.mimet.2018.01.012CrossRefPubMed

49.

Yoo IY, Han J, Ha SI, Cha YJ, Pil SD, Park YJ (2021) Clinical performance of ASTA SepsiPrep kit in direct bacterial identification and antimicrobial susceptibility test using MicroIDSys Elite and VITEK-2 system. J Clin Lab Anal 35:e23744. https://doi.org/10.1002/jcla.23744CrossRefPubMedPubMedCentral

50.

Watanabe N, Koyama S, Taji Y, Mitsutake K, Ebihara Y (2022) Direct microorganism species identification and antimicrobial susceptibility tests from positive blood culture bottles using rapid Sepsityper Kit. J Infect Chemother 28:563–568. https://doi.org/10.1016/j.jiac.2021.12.030CrossRefPubMed

51.

Liu W, Liao K, Wu J et al (2024) Blood culture quality and turnaround time of clinical microbiology laboratories in Chinese teaching hospitals: a multicenter study. J Clin Lab Anal 38:e25008. https://doi.org/10.1002/jcla.25008CrossRefPubMedPubMedCentral

Titel: The impact of optimizing microbial diagnosis processes on clinical and healthcare economic outcomes in hospitalized patients with bloodstream infections
verfasst von: Genwei Ai
Ying Zhang
Kunshan Guo
Lu Zhao
Zhi Li
He Hai
Erjuan Jia
Junying Liu
Publikationsdatum: 06.09.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Clinical Microbiology & Infectious Diseases / Ausgabe 11/2024
Print ISSN: 0934-9723
Elektronische ISSN: 1435-4373
DOI: https://doi.org/10.1007/s10096-024-04928-2

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The impact of optimizing microbial diagnosis processes on clinical and healthcare economic outcomes in hospitalized patients with bloodstream infections