Rapid diagnostic testing combined with an immediate infectious disease consultation increases the rate of septic intensive care unit patients on targeted antibiotic therapy
ObjectivesTo evaluate the impact of rapid diagnostic testing (RDT) combined with immediate infectious disease (ID) consultation on the treatment of septic patients with positive blood cultures in intensive care units in a setting without 24/7 service.MethodsAdult ICU patients in a tertiary care hosp...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-01-01
|
| Series: | Frontiers in Cellular and Infection Microbiology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcimb.2024.1513408/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832592650526523392 |
|---|---|
| author | Evelyn Kramme Nadja Käding Nadja Käding Tobias Graf Karolin Schmoll Heidi Linnen Katharina Nagel Esther Grote-Levi Susanne Hauswaldt Dennis Nurjadi Dennis Nurjadi Jan Rupp Jan Rupp Jan Rupp |
| author_facet | Evelyn Kramme Nadja Käding Nadja Käding Tobias Graf Karolin Schmoll Heidi Linnen Katharina Nagel Esther Grote-Levi Susanne Hauswaldt Dennis Nurjadi Dennis Nurjadi Jan Rupp Jan Rupp Jan Rupp |
| author_sort | Evelyn Kramme |
| collection | DOAJ |
| description | ObjectivesTo evaluate the impact of rapid diagnostic testing (RDT) combined with immediate infectious disease (ID) consultation on the treatment of septic patients with positive blood cultures in intensive care units in a setting without 24/7 service.MethodsAdult ICU patients in a tertiary care hospital with positive blood cultures were included from January 2019 to December 2020. The control group underwent routine laboratory testing, and for the intervention group, RDT was applied with immediate ID consultation.ResultsIn 77 out of the 91 patients in the intervention group, the pathogen was identified by RDT. Regarding antimicrobial susceptibility testing (AST), genotypic testing (ePlex®) was successful for Gram-positive cocci, but inadequate for Gram-negative rods. Phenotypic resistance testing with the Accelerate PhenoTest® took too long to be successfully integrated into the intervention. Adaptation of empirical antibiotic therapy was recommended for 72.7% of the patients. Adherence to the ID consultation post-RDT results was high at 82.3%. In the control group, adaptation of the initial antibiotic therapy would have been recommended for 81.8% of patients, if the species identification had been available. Overall adherence to the local antibiotic therapy guideline for sepsis was significantly lower in the control than in the intervention group (27.8% versus 89.3%, p<0.001).ConclusionIntegration of an RDT system in the microbiological workflow for septic patients in ICU combined with a standardized ID intervention led to a significantly higher percentage of adequate antimicrobial treatment and greater adherence to local antibiotic therapy recommendations, even in a setting where 24/7 service is not available. |
| format | Article |
| id | doaj-art-7a8d0b84286743fc812fedd090966869 |
| institution | Kabale University |
| issn | 2235-2988 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cellular and Infection Microbiology |
| spelling | doaj-art-7a8d0b84286743fc812fedd0909668692025-01-21T05:43:41ZengFrontiers Media S.A.Frontiers in Cellular and Infection Microbiology2235-29882025-01-011410.3389/fcimb.2024.15134081513408Rapid diagnostic testing combined with an immediate infectious disease consultation increases the rate of septic intensive care unit patients on targeted antibiotic therapyEvelyn Kramme0Nadja Käding1Nadja Käding2Tobias Graf3Karolin Schmoll4Heidi Linnen5Katharina Nagel6Esther Grote-Levi7Susanne Hauswaldt8Dennis Nurjadi9Dennis Nurjadi10Jan Rupp11Jan Rupp12Jan Rupp13Department of Infectious Diseases, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, GermanyInstitute of Medical Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, GermanyGerman Center for Infection Research, Hamburg-Lübeck-Borstel-Riems site, Lübeck, GermanyUniversity Heart Center Lübeck and German Center for Cardiovascular Research, University Hospital Schleswig-Holstein, Lübeck, GermanyUniversity Heart Center Lübeck and German Center for Cardiovascular Research, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Anaesthesiology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, GermanyInstitute of Medical Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, GermanyInstitute of Medical Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, GermanyInstitute of Medical Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, GermanyInstitute of Medical Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, GermanyGerman Center for Infection Research, Hamburg-Lübeck-Borstel-Riems site, Lübeck, GermanyDepartment of Infectious Diseases, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, GermanyInstitute of Medical Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, GermanyGerman Center for Infection Research, Hamburg-Lübeck-Borstel-Riems site, Lübeck, GermanyObjectivesTo evaluate the impact of rapid diagnostic testing (RDT) combined with immediate infectious disease (ID) consultation on the treatment of septic patients with positive blood cultures in intensive care units in a setting without 24/7 service.MethodsAdult ICU patients in a tertiary care hospital with positive blood cultures were included from January 2019 to December 2020. The control group underwent routine laboratory testing, and for the intervention group, RDT was applied with immediate ID consultation.ResultsIn 77 out of the 91 patients in the intervention group, the pathogen was identified by RDT. Regarding antimicrobial susceptibility testing (AST), genotypic testing (ePlex®) was successful for Gram-positive cocci, but inadequate for Gram-negative rods. Phenotypic resistance testing with the Accelerate PhenoTest® took too long to be successfully integrated into the intervention. Adaptation of empirical antibiotic therapy was recommended for 72.7% of the patients. Adherence to the ID consultation post-RDT results was high at 82.3%. In the control group, adaptation of the initial antibiotic therapy would have been recommended for 81.8% of patients, if the species identification had been available. Overall adherence to the local antibiotic therapy guideline for sepsis was significantly lower in the control than in the intervention group (27.8% versus 89.3%, p<0.001).ConclusionIntegration of an RDT system in the microbiological workflow for septic patients in ICU combined with a standardized ID intervention led to a significantly higher percentage of adequate antimicrobial treatment and greater adherence to local antibiotic therapy recommendations, even in a setting where 24/7 service is not available.https://www.frontiersin.org/articles/10.3389/fcimb.2024.1513408/fullsepsisrapid diagnostic testinginfectious diseases consultationadequate antibiotic therapyblood stream infection (BSI)antimicrobial stewardship (AMS) |
| spellingShingle | Evelyn Kramme Nadja Käding Nadja Käding Tobias Graf Karolin Schmoll Heidi Linnen Katharina Nagel Esther Grote-Levi Susanne Hauswaldt Dennis Nurjadi Dennis Nurjadi Jan Rupp Jan Rupp Jan Rupp Rapid diagnostic testing combined with an immediate infectious disease consultation increases the rate of septic intensive care unit patients on targeted antibiotic therapy Frontiers in Cellular and Infection Microbiology sepsis rapid diagnostic testing infectious diseases consultation adequate antibiotic therapy blood stream infection (BSI) antimicrobial stewardship (AMS) |
| title | Rapid diagnostic testing combined with an immediate infectious disease consultation increases the rate of septic intensive care unit patients on targeted antibiotic therapy |
| title_full | Rapid diagnostic testing combined with an immediate infectious disease consultation increases the rate of septic intensive care unit patients on targeted antibiotic therapy |
| title_fullStr | Rapid diagnostic testing combined with an immediate infectious disease consultation increases the rate of septic intensive care unit patients on targeted antibiotic therapy |
| title_full_unstemmed | Rapid diagnostic testing combined with an immediate infectious disease consultation increases the rate of septic intensive care unit patients on targeted antibiotic therapy |
| title_short | Rapid diagnostic testing combined with an immediate infectious disease consultation increases the rate of septic intensive care unit patients on targeted antibiotic therapy |
| title_sort | rapid diagnostic testing combined with an immediate infectious disease consultation increases the rate of septic intensive care unit patients on targeted antibiotic therapy |
| topic | sepsis rapid diagnostic testing infectious diseases consultation adequate antibiotic therapy blood stream infection (BSI) antimicrobial stewardship (AMS) |
| url | https://www.frontiersin.org/articles/10.3389/fcimb.2024.1513408/full |
| work_keys_str_mv | AT evelynkramme rapiddiagnostictestingcombinedwithanimmediateinfectiousdiseaseconsultationincreasestherateofsepticintensivecareunitpatientsontargetedantibiotictherapy AT nadjakading rapiddiagnostictestingcombinedwithanimmediateinfectiousdiseaseconsultationincreasestherateofsepticintensivecareunitpatientsontargetedantibiotictherapy AT nadjakading rapiddiagnostictestingcombinedwithanimmediateinfectiousdiseaseconsultationincreasestherateofsepticintensivecareunitpatientsontargetedantibiotictherapy AT tobiasgraf rapiddiagnostictestingcombinedwithanimmediateinfectiousdiseaseconsultationincreasestherateofsepticintensivecareunitpatientsontargetedantibiotictherapy AT karolinschmoll rapiddiagnostictestingcombinedwithanimmediateinfectiousdiseaseconsultationincreasestherateofsepticintensivecareunitpatientsontargetedantibiotictherapy AT heidilinnen rapiddiagnostictestingcombinedwithanimmediateinfectiousdiseaseconsultationincreasestherateofsepticintensivecareunitpatientsontargetedantibiotictherapy AT katharinanagel rapiddiagnostictestingcombinedwithanimmediateinfectiousdiseaseconsultationincreasestherateofsepticintensivecareunitpatientsontargetedantibiotictherapy AT esthergrotelevi rapiddiagnostictestingcombinedwithanimmediateinfectiousdiseaseconsultationincreasestherateofsepticintensivecareunitpatientsontargetedantibiotictherapy AT susannehauswaldt rapiddiagnostictestingcombinedwithanimmediateinfectiousdiseaseconsultationincreasestherateofsepticintensivecareunitpatientsontargetedantibiotictherapy AT dennisnurjadi rapiddiagnostictestingcombinedwithanimmediateinfectiousdiseaseconsultationincreasestherateofsepticintensivecareunitpatientsontargetedantibiotictherapy AT dennisnurjadi rapiddiagnostictestingcombinedwithanimmediateinfectiousdiseaseconsultationincreasestherateofsepticintensivecareunitpatientsontargetedantibiotictherapy AT janrupp rapiddiagnostictestingcombinedwithanimmediateinfectiousdiseaseconsultationincreasestherateofsepticintensivecareunitpatientsontargetedantibiotictherapy AT janrupp rapiddiagnostictestingcombinedwithanimmediateinfectiousdiseaseconsultationincreasestherateofsepticintensivecareunitpatientsontargetedantibiotictherapy AT janrupp rapiddiagnostictestingcombinedwithanimmediateinfectiousdiseaseconsultationincreasestherateofsepticintensivecareunitpatientsontargetedantibiotictherapy |