292 - Impact of the BACT/ALERT VIRTUO blood culture system in the management of Staphylococcus aureus bacteremia

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Presenting Author(s)

Miguel A. Chavez

Instructor in Medicine
Washington University in St. Louis
St. Louis, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

SM

Satish Munigala

MBBS, MPH
Washington University School of Medicine in St. Louis
St. Louis, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Carey-Ann Burnham

Professor of Pathology & Immunology, Molecular Microbiology, Pediatrics, and Medicine
Washington University
St. Louis, MO
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
David K. Warren

Professor of Medicine
Washington University School of Medicine in St. Louis
Saint Louis, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Staphylococcus aureus bacteremia (SAB) is a major cause of mortality. Recovery of SA may be enhanced with new blood culture systems resulting in a longer observed duration of bacteremia.

Methods: We performed a 24-month retrospective study of adults hospitalized with SAB at a 1250-bed academic hospital. Between 1/2018-12/2018 the VersaTREK system was used and 1/2019-12/2019 the BACT/ALERT VIRTUO (VIRTUO) system was used. We excluded patients without an Infectious Diseases (ID) consult. We defined SAB duration as short (1-2 days), intermediate (3-6 days), or prolonged (>7 days). We compared SAB detection and management pre- and post-implementation of VIRTUO.

Results: 456 patients had SAB during study period; 420 (92%) had ID consultation: 178 (42%) pre- and 242 (58%) post-implementation. Similar proportion of methicillin-resistant SAB was seen (44.9% pre- vs. 36.8% post-implementation, p=0.09). Post-implementation, patients were more likely to have intermediate (22.4% pre- vs. 40.1% post-implementation; p< 0.001) and prolonged SAB duration (3.9% pre- vs. 13.6% post-implementation; p< 0.001). Median time to positivity for the index blood culture was shorter (19.9 pre- vs. 15.0 hours post-implementation, p< 0.001). Dual anti-staphylococcal therapy was used more frequently in the post-implementation period (6.2% pre- vs. 15.7% post-implementation, p=0.003). No difference was noted in frequency of diagnostic studies (transesophageal echocardiography, magnetic resonance imaging, and computed tomography). Source control was similar (46.1% pre- vs. 45.0% post-implementation; p=0.84) but the median time to source-control was shorter post-implementation (4 pre- vs. 2 days post-implementation; p=0.02). Median planned duration of intravenous antibiotics did not vary between pre- and post-implementation periods (6 vs. 6 weeks, p=0.31). There was no difference in 90-day readmissions (38.2% pre- vs. 34.3% post-implementation; p=0.41).

Conclusion: VIRTUO blood culture system decreased time to positivity and increased frequency of prolonged SAB compared to the VersaTREK system. This resulted in increased use of dual anti-staphylococcal therapy and shorter time to source-control, but no difference in interventions, planned duration of antibiotics, or readmissions.