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Clinical Outcomes with Implementation of Accelerate Pheno™ Blood Culture Detection System for Gram-Negative Bacteremia

Delayed treatment in bacteremia increases patient morbidity and healthcare costs. Accelerate Pheno™ Blood Culture Detection System (AXDX) is a novel diagnostic technology for the rapid detection of gram-negative bacteremia. Studies have shown accurate and faster time to speciation and sensitivity (TTSS) by AXDX compared to conventional modality. However, however, our study further examined the direct impact of AXDX on clinical outcomes and cost. Our retrospective study consisted of 178 patients at least 18 years old admitted to our academic medical institution with gram-negative bacteremia. The pre-AXDX group had 91 patients admitted in 2019 while the post-AXDX group had 87 patients admitted in 2021. Demographics, microbes, TTSS, time to de-escalation of therapy (TTDeT), length of stay (LOS), readmissions, and Clostridioides difficile infection (CDI) rates were recorded and differences between the cohorts were statistically analyzed. The pre-AXDX group had 51.32% females, mean age of 60.28 years, mean Charlson Co-morbidity Index (CCMI) of 2.23, mean LOS of 21.19 days, and mean Pitt-Bacteremia Score (PBS) of 2.35. The post-AXDX group had 51.92% females, mean age of 63.66 years, mean CCMI of 2.99, median LOS of 15.02 days, and mean PBS of 2.71. Both groups’ top two sources of bacteremia were urinary and gastrointestinal and the two most common microbes were Escherichia coli and Klebsiella pneumoniae. Pre-AXDX's mean TTSS was 70.95 hours and 62.92 hours for post-AXDX. Pre-AXDX's mean TTDeT was 73.90 hours and 43.85 hours for post-AXDX. The pre-AXDX cohort had 7.12% increase in related readmissions, 5.45% more CDI, and 0.26% increase in inpatient mortality. In addition to faster TTSS with AXDX as seen with previous studies, our study shows clinical advantages with AXDX use. While both groups were comparable in bacteremia sources and microbes. The post-AXDX group had higher CCMI and PBS scores, indicating they were more ill. Despite this, the pre-AXDX group had longer TTDeT by 30.05 hours, longer mean LOS by 6.17 days, 5.45% more CDI, 7.12% more readmissions, and 0.26% more mortality rates. The pre-AXDX group also reported adverse reactions to antibiotics while the post-AXDX had none. Our data shows AXDX use improves clinical outcomes with fewer adverse effects, mortality, and CDI rates and decreases cost with shorter LOS and lower readmission rates.

Gram-Negative Bacteremia, Rapid Diagnostic Technology, Outcomes, Costs

APA Style

Shu Xian Lee, Benita Yong Wu, Kurt Suter, Matthew Scott Lokant, Andrew Ward, et al. (2023). Clinical Outcomes with Implementation of Accelerate Pheno™ Blood Culture Detection System for Gram-Negative Bacteremia. American Journal of Laboratory Medicine, 8(3), 27-34. https://doi.org/10.11648/j.ajlm.20230803.11

ACS Style

Shu Xian Lee; Benita Yong Wu; Kurt Suter; Matthew Scott Lokant; Andrew Ward, et al. Clinical Outcomes with Implementation of Accelerate Pheno™ Blood Culture Detection System for Gram-Negative Bacteremia. Am. J. Lab. Med. 2023, 8(3), 27-34. doi: 10.11648/j.ajlm.20230803.11

AMA Style

Shu Xian Lee, Benita Yong Wu, Kurt Suter, Matthew Scott Lokant, Andrew Ward, et al. Clinical Outcomes with Implementation of Accelerate Pheno™ Blood Culture Detection System for Gram-Negative Bacteremia. Am J Lab Med. 2023;8(3):27-34. doi: 10.11648/j.ajlm.20230803.11

Copyright © 2023 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Accelerate Pheno® system. (n. d.). Retrieved May 21, 2022, from https://acceleratediagnostics.com/products/accelerate-pheno-system/#features.
2. Babowicz, F., LaPlante, R., Mitchell, C., Nicholas O’Donnell, J., Tobin, E., George, M., & Carreno, J. J. (2021). Impact of accelerate pheno and BacT/Alert virtuo on clinical processes and outcomes in patients with sepsis and concurrent gram-negative bacteremia. Antimicrobial Agents and Chemotherapy, 65 (6). https://doi.org/10.1128/AAC.02364-20.
3. Banerjee, R., Komarow, L., Virk, A., Rajapakse, N., Schuetz, A. N., Dylla, B., Earley, M., Lok, J., Kohner, P., Ihde, S., Cole, N., Hines, L., Reed, K., Garner, O. B., Chandrasekaran, S., de St. Maurice, A., Kanatani, M., Curello, J., Arias, R., … Patel, R. (2021). Randomized Trial Evaluating Clinical Impact of RAPid IDentification and Susceptibility Testing for Gram-negative Bacteremia: RAPIDS-GN. Clinical Infectious Diseases, 73 (1). https://doi.org/10.1093/cid/ciaa528.
4. Bhalodi, A. A., MacVane, S. H., Ford, B., Ince, D., Kinn, P. M., Percival, K. M., Bremmer, D. N., Carr, D. R., Walsh, T. L., Bhatti, M. M., Shelburne, S. A., Humphries, R. M., Wolfe, K., Rosenbaum, E. R., Dare, R. K., Kolev, J., Madhusudhan, M., Ben-Aderet, M. A., & Morgan, M. A. (2021). Real-World Impact of the Accelerate PhenoTest ® BC Kit on patients with bloodstream infections in IOAS (Improving Outcomes and Antimicrobial Stewardship): A Quasi-Experimental Multicenter Study. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. https://doi.org/10.1093/CID/CIAB921.
5. Bonine NG, Berger A, Altincatal A, et al. Impact of Delayed Appropriate Antibiotic Therapy on Patient Outcomes by Antibiotic Resistance Status From Serious Gram-negative Bacterial Infections. Am J Med Sci. 2019; 357 (2): 103-110. doi: 10.1016/j.amjms.2018.11.009.
6. Burnham, J., Wallace, M., Fuller, B., Burnham, C.-A. D., & Kollef, M. (2017). Clinical Impact of Expedited Pathogen Identification and Susceptibility Testing for Gram-negative Bacteremia and Candidemia Using the Accelerate PhenoTM System. Open Forum Infectious Diseases, 4 (suppl_1). https://doi.org/10.1093/ofid/ofx163.1649.
7. Dare, R. K., Lusardi, K., Pearson, C., McCain, K. D., Daniels, K. B., Van, S., Rico, J. C., Painter, J., Lakkad, M., Rosenbaum, E. R., & Bariola, J. R. (2021). Clinical Impact of Accelerate Pheno Rapid Blood Culture Detection System in Bacteremic Patients. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 73 (11). https://doi.org/10.1093/cid/ciaa649.
8. Dare, R., McCain, K., Lusardi, K., Daniels, K., Painter, J., Lakkad, M., Emery, N., Rosenbaum, E., & Bariola, J. R. (2018). 1758. Impact of Accelerate PhenoTM Rapid Blood Culture Detection System on Laboratory and Clinical Outcomes in Bacteremic Patients. Open Forum Infectious Diseases, 5 (suppl_1). https://doi.org/10.1093/ofid/ofy209.143.
9. Ehren, K., Meißner, A., Jazmati, N., Wille, J., Jung, N., Vehreschild, J. J., Hellmich, M., & Seifert, H. (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. Clinical Infectious Diseases, 70 (7). https://doi.org/10.1093/cid/ciz406.
10. Ganapathiraju, I., Bushman, A., & Espinoza, R. R. (2020). 108. Impact of Accelerate Pheno System in the Management of Gram-Negative Rod Bacteremia. Open Forum Infectious Diseases, 7 (Supplement_1). https://doi.org/10.1093/ofid/ofaa439.153.
11. Ganapathiraju, I., Bushman, A., Rossana, Espinoza, R., Powers, C., Moenster, R. P., & Linneman, T. W. (2020). 109. Impact of Accelerate PhenoTM System on Time to De-escalation of Antimicrobial Therapy. Open Forum Infectious Diseases, 7 (Supplement_1), S69–S69. https://doi.org/10.1093/OFID/OFAA439.154.
12. Goto, M., & Al-Hasan, M. N. (2013). Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clinical Microbiology and Infection, 19 (6), 501–509. https://doi.org/10.1111/1469-0691.12195.
13. Kilgore, M., & Brossette, S. (2008). Cost of bloodstream infections. American Journal of Infection Control, 36 (10), S172.e1-S172.e3. https://doi.org/10.1016/J.AJIC.2008.10.004.
14. Lee, M., Scardina, T., Zheng, X., & Patel, S. J. (2020). Clinical Performance and Impact of Accelerate Pheno for Gram-negative Bacteremia in Hospitalized Children. Clinical Therapeutics, 42 (9). https://doi.org/10.1016/j.clinthera.2020.07.015.
15. Liu, Vincent et al. “Hospital deaths in patients with sepsis from 2 independent cohorts.” JAMA vol. 312, 1 (2014): 90-2. doi: 10.1001/jama.2014.5804.
16. Muñoz, P., Cruz, A. F., Rodríguez-Créixems, M., & Bouza, E. (2008). Gram-negative bloodstream infections. International Journal of Antimicrobial Agents, 32 (SUPPL. 1), S10–S14. https://doi.org/10.1016/J.IJANTIMICAG.2008.06.015.
17. Pearson, C., Lusardi, K., McCain, K., Painter, J., Lakkad, M., Rosenbaum, E. R., Daniels, K., Van, S., Bariola, J. R., & Dare, R. K. (2019). 2137. Impact of Accelerate PhenoTM Rapid Blood Culture Detection System with Real-time Notification vs. Standard Antibiotic Stewardship on Clinical Outcomes in Bacteremic Patients. Open Forum Infectious Diseases, 6 (Supplement_2). https://doi.org/10.1093/ofid/ofz360.1817.
18. Pien, B. C., Sundaram, P., Raoof, N., Costa, S. F., Mirrett, S., Woods, C. W., Reller, L. B., & Weinstein, M. P. (2010). The clinical and prognostic importance of positive blood cultures in adults. American Journal of Medicine, 123 (9), 819–828. https://doi.org/10.1016/J.AMJMED.2010.03.021.
19. Pliakos, E. E., Andreatos, N., Shehadeh, F., Ziakas, P. D., & Mylonakis, E. (2018). The cost-effectiveness of rapid diagnostic testing for the diagnosis of bloodstream infections with or without antimicrobial stewardship. Clinical Microbiology Reviews, 31 (3). https://doi.org/10.1128/CMR.00095-17/FORMAT/EPUB.
20. Raman, G., Avendano, E., Berger, S., & Menon, V. (2015). Appropriate initial antibiotic therapy in hospitalized patients with gram-negative infections: systematic review and meta-analysis. BMC Infectious Diseases, 15 (1), 1–11. https://doi.org/10.1186/S12879-015-1123-5.
21. Rhee, Chanu et al. “Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014.” JAMA vol. 318, 13 (2017): 1241-1249. doi: 10.1001/jama.2017.13836.
22. Rhee, C., Jones, T. M., Hamad, Y., Pande, A., Varon, J., O’Brien, C., Anderson, D. J., Warren, D. K., Dantes, R. B., Epstein, L., & Klompas, M. (2019). Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals. JAMA Network Open, 2 (2). https://doi.org/10.1001/jamanetworkopen.2018.7571.
23. Schneider, J. G., Wood, J. B., Schmitt, B. H., Emery, C. L., Davis, T. E., Smith, N. W., Blevins, S., Hiles, J., Desai, A., Wrin, J., Bocian, B., & Manaloor, J. J. (2019). Susceptibility Provision Enhances Effective De-escalation (SPEED): Utilizing rapid phenotypic susceptibility testing in Gram-negative bloodstream infections and its potential clinical impact. Journal of Antimicrobial Chemotherapy, 74. https://doi.org/10.1093/jac/dky531.
24. Sheth, S., Miller, M., Prouse, A. B., & Baker, S. (2020). Pharmacist-driven implementation of fast identification and antimicrobial susceptibility testing improves outcomes for patients with gram-negative bacteremia and candidemia. Antimicrobial Agents and Chemotherapy, 64 (9). https://doi.org/10.1128/AAC.00578-20.
25. Singh, G. K., & Siahpush, M. (2014). Widening Rural–Urban Disparities in Life Expectancy, U.S., 1969–2009. American Journal of Preventive Medicine, 46 (2), e19–e29. https://doi.org/10.1016/J.AMEPRE.2013.10.017.
26. Stryjewski, M. E., & Boucher, H. W. (2009). Gram-negative bloodstream infections. International Journal of Antimicrobial Agents, 34, S21–S25. https://doi.org/10.1016/S0924-8579(09)70561-8.
27. Thorpe, K. E., Joski, P., & Johnston, K. J. (2018). Antibiotic-resistant infection treatment costs have doubled since 2002, now exceeding $2 billion annually. Health Affairs, 37 (4), 662–669. https://doi.org/10.1377/HLTHAFF.2017.1153/ASSET/IMAGES/LARGE/FIGUREEX2.JPEG.
28. Trotter, A. J., Aydin, A., Strinden, M. J., & O’Grady, J. (2019). Recent and emerging technologies for the rapid diagnosis of infection and antimicrobial resistance. In Current Opinion in Microbiology (Vol. 51). https://doi.org/10.1016/j.mib.2019.03.001.
29. Ullberg, M., & Özenci, V. (2020). Identification and antimicrobial susceptibility testing of Gram-positive and Gram-negative bacteria from positive blood cultures using the Accelerate PhenoTM system. European Journal of Clinical Microbiology and Infectious Diseases, 39 (1). https://doi.org/10.1007/s10096-019-03703-y.
30. Walsh, T. L., Bremmer, D. N., Moffa, M. A., Trienski, T. L., Buchanan, C., Stefano, K., Hand, C., Taylor, T., Kasarda, K., Shively, N. R., Bhanot, N., Cheronis, N., DiSilvio, B. E., Cho, C. Y., & Carr, D. R. (2021). Impact of an Antimicrobial Stewardship Program-bundled initiative utilizing Accelerate PhenoTM system in the management of patients with aerobic Gram-negative bacilli bacteremia. Infection, 49 (3). https://doi.org/10.1007/s15010-021-01581-1.
31. Zeitler, K., & Narayanan, N. (2019). The Present and Future State of Antimicrobial Stewardship and Rapid Diagnostic Testing: Can One Ideally Succeed Without the Other? Current Treatment Options in Infectious Diseases, 11 (2). https://doi.org/10.1007/s40506-019-00190-9.
32. Zhang, D., Prabhu, V. S., & Marcella, S. W. (2018). Attributable Healthcare Resource Utilization and Costs for Patients with Primary and Recurrent Clostridium difficile Infection in the United States. Clinical Infectious Diseases, 66 (9), 1326–1332. https://doi.org/10.1093/CID/CIX1021.
33. Healthcare cost and Utilization Project (HCUP) fast stats. HCUP Fast Stats Data Tools | AHRQ Data Tools. (n. d.). Retrieved February 22, 2023, from https://datatools.ahrq.gov/hcup-fast-stats.
34. Kim H, Mahmood A, Hammarlund NE, Chang CF. Hospital value-based payment programs and disparity in the United States: A review of current evidence and future perspectives. Front Public Health. 2022; 10: 882715. Published 2022 Oct 10. doi: 10.3389/fpubh.2022.882715.
35. Torio, C., Moore, B. (2016). National inpatient hospital costs: The most expensive conditions by payer 2013. Agency for Healthcare Research and Quality.
36. McNamara JF, Harris PNA, Chatfield MD, Paterson DL. Long term sepsis readmission, mortality and cause of death following Gram negative bloodstream infection: a propensity matched observational linkage study. Int J Infect Dis. 2022; 114: 34-44. doi: 10.1016/j.ijid.2021.10.047.