107 - Impact of a Rapid Blood Culture Identification Panel at a Community Teaching Hospital: a Pre-Post Quasi-Experiment

Background: Rapid diagnostic tests (RDT) for positive blood cultures can lead to quicker identification of organisms and key resistance elements. As a result time to targeted therapy may decrease, thus reducing the duration of broad, empiric antibiotic use. The purpose of this study was to determine the impact of implementing the BioFire® FilmArray® Blood Culture Identification (BCID) Panel for gram-positive organisms on antimicrobial process measures and patient outcomes at an academic community hospital.

Methods: This was a single-center, pre-post intervention, quasi-experimental study evaluating hospitalized adult patients who had at least one positive blood culture with gram-positive organisms from June 1, 2018 to August 31, 2018 and June 1, 2019 to August 31, 2019. Patients in the pre-intervention group were randomized and post-intervention patients were matched by identified organism. The primary outcome was the time to targeted therapy from blood culture collection.  Secondary outcomes included time to targeted therapy from positive Gram stain, vancomycin and anti-pseudomonal β-lactam length of therapy (LOT), institutional vancomycin days of therapy (DOT), length of stay (LOS), and estimated hospitalization costs.

Results: A total of 75 patients in each group were included. The time to targeted therapy from blood culture collection was significantly decreased after RDT implementation [32.9 (23.2-51.8) hours vs. 49.2 (37.1-76.3 hours, p < 0.001)], as was time to targeted therapy from Gram stain results [8.5 (0-25.2) hours vs. 30 (19.4-52.9) hours, p < 0.001]. No difference was found between the groups with respect to LOS or estimated hospitalization cost. Overall the vancomycin LOT [0.86 (0.09-2.38) days vs. 2.18 (1.37-4.34) days, p = 0.001] and anti-pseudomonal β-lactam LOT for MRSA, MSSA, Streptococcus, and Enterococcus subgroup [1.15 (0.06-2.07) vs. 1.78 (1.28-2.89) days, p = 0.026] were significantly decreased in the post-RDT group.Table 1: Demographics and Baseline Characteristics
Table 2: Secondary Outcomes
Figure 1: Institutional Use of Vnacomycin


Conclusion: Implementation of a rapid diagnostic test on gram-positive blood cultures was associated with decreased time to targeted therapy from blood culture collection, time to targeted therapy from positive culture, and vancomycin LOT.