The Clinical Impact of Early Detection of ESBL-Producing Enterobacterales with PCR-Based Blood Culture Assays

Link to article at PubMed

Am J Infect Control. 2023 Aug 4:S0196-6553(23)00545-X. doi: 10.1016/j.ajic.2023.08.001. Online ahead of print.


INTRODUCTION: Starting January 4, 2021, our health system core microbiology laboratory changed blood culture identification (BCID) platforms to ePlex® BCID from BioFire® BCID1 with the additional capability to detect blaCTX-M-Type gene of ESBL-producing organisms. Clinical outcomes of ESBL BSI after implementing ePlex BCID were unknown.

METHODS: Patients with ESBL BSI were compared pre- and post-implementation of ePlex BCID in this 11-hospital retrospective analysis (BioFire BCID1 in 2019 vs. ePlex BCID in 2021). The primary outcome was time from the Gram stain result to escalation to a carbapenem. Secondary outcomes included in-hospital mortality, 30-day readmission rate, length of stay (LOS), and the duration of antimicrobial therapy.

RESULTS: A total of 275 patients were analyzed. The median time of Gram stain result to escalation to a carbapenem was reduced from 44.5 hours with BioFire BCID1 to 7.9 hours with ePlex BCID (p<0.001). There were no significant differences in mortality, 30-day readmission, or LOS. The duration of antimicrobial therapy for ESBL BSI was lower in the ePlex BCID group (from 14.4 days to 12.7 days, p=0.014).

CONCLUSION: Timely detection of blaCTX-M-Type gene by BCID provides valuable information for early initiation of appropriate and effective antimicrobial therapy. Although it was not associated with lower mortality, 30-day readmission, or LOS, it may have benefits such as decreasing antimicrobial exposure to patients.

PMID:37544512 | DOI:10.1016/j.ajic.2023.08.001

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