Randomized Trial Evaluating Clinical Impact of RAPid IDentification and Susceptibility Testing for Gram-negative Bacteremia: RAPIDS-GN
BACKGROUNDRapid blood culture diagnostics are of unclear benefit for patients with gram-negative bacilli (GNB) bloodstream infections (BSIs). We conducted a multicenter, randomized, controlled trial comparing outcomes of patients with GNB BSIs who had blood culture testing with standard-of-care (SOC...
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| Veröffentlicht in: | Clinical infectious diseases 2021-07, Vol.73 (1), p.e39-e46 |
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| creator | Banerjee, Ritu Komarow, Lauren Virk, Abinash Rajapakse, Nipunie Schuetz, Audrey N Dylla, Brenda Earley, Michelle Lok, Judith Kohner, Peggy Ihde, Sherry Cole, Nicolynn Hines, Lisa Reed, Katelyn Garner, Omai B Chandrasekaran, Sukantha de St. Maurice, Annabelle Kanatani, Meganne Curello, Jennifer Arias, Rubi Swearingen, William Doernberg, Sarah B Patel, Robin |
| description | BACKGROUNDRapid blood culture diagnostics are of unclear benefit for patients with gram-negative bacilli (GNB) bloodstream infections (BSIs). We conducted a multicenter, randomized, controlled trial comparing outcomes of patients with GNB BSIs who had blood culture testing with standard-of-care (SOC) culture and antimicrobial susceptibility testing (AST) vs rapid organism identification (ID) and phenotypic AST using the Accelerate Pheno System (RAPID). METHODSPatients with positive blood cultures with Gram stains showing GNB were randomized to SOC testing with antimicrobial stewardship (AS) review or RAPID with AS. The primary outcome was time to first antibiotic modification within 72 hours of randomization. RESULTSOf 500 randomized patients, 448 were included (226 SOC, 222 RAPID). Mean (standard deviation) time to results was faster for RAPID than SOC for organism ID (2.7 [1.2] vs 11.7 [10.5] hours; P |
| doi_str_mv | 10.1093/cid/ciaa528 |
| format | Article |
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We conducted a multicenter, randomized, controlled trial comparing outcomes of patients with GNB BSIs who had blood culture testing with standard-of-care (SOC) culture and antimicrobial susceptibility testing (AST) vs rapid organism identification (ID) and phenotypic AST using the Accelerate Pheno System (RAPID). METHODSPatients with positive blood cultures with Gram stains showing GNB were randomized to SOC testing with antimicrobial stewardship (AS) review or RAPID with AS. The primary outcome was time to first antibiotic modification within 72 hours of randomization. RESULTSOf 500 randomized patients, 448 were included (226 SOC, 222 RAPID). Mean (standard deviation) time to results was faster for RAPID than SOC for organism ID (2.7 [1.2] vs 11.7 [10.5] hours; P < .001) and AST (13.5 [56] vs 44.9 [12.1] hours; P < .001). Median (interquartile range [IQR]) time to first antibiotic modification was faster in the RAPID arm vs the SOC arm for overall antibiotics (8.6 [2.6-27.6] vs 14.9 [3.3-41.1] hours; P = .02) and gram-negative antibiotics (17.3 [4.9-72] vs 42.1 [10.1-72] hours; P < .001). Median (IQR) time to antibiotic escalation was faster in the RAPID arm vs the SOC arm for antimicrobial-resistant BSIs (18.4 [5.8-72] vs 61.7 [30.4-72] hours; P = .01). There were no differences between the arms in patient outcomes. CONCLUSIONSRapid organism ID and phenotypic AST led to faster changes in antibiotic therapy for gram-negative BSIs. CLINICAL TRIALS REGISTRATIONNCT03218397.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciaa528</identifier><identifier>PMID: 32374822</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Online Only</subject><ispartof>Clinical infectious diseases, 2021-07, Vol.73 (1), p.e39-e46</ispartof><rights>The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c358t-9b316f99951f816cd96e6290685540c9a133d023f6a64f2609663fbdf4d879b33</citedby><cites>FETCH-LOGICAL-c358t-9b316f99951f816cd96e6290685540c9a133d023f6a64f2609663fbdf4d879b33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27903,27904</link.rule.ids></links><search><creatorcontrib>Banerjee, Ritu</creatorcontrib><creatorcontrib>Komarow, Lauren</creatorcontrib><creatorcontrib>Virk, Abinash</creatorcontrib><creatorcontrib>Rajapakse, Nipunie</creatorcontrib><creatorcontrib>Schuetz, Audrey N</creatorcontrib><creatorcontrib>Dylla, Brenda</creatorcontrib><creatorcontrib>Earley, Michelle</creatorcontrib><creatorcontrib>Lok, Judith</creatorcontrib><creatorcontrib>Kohner, Peggy</creatorcontrib><creatorcontrib>Ihde, Sherry</creatorcontrib><creatorcontrib>Cole, Nicolynn</creatorcontrib><creatorcontrib>Hines, Lisa</creatorcontrib><creatorcontrib>Reed, Katelyn</creatorcontrib><creatorcontrib>Garner, Omai B</creatorcontrib><creatorcontrib>Chandrasekaran, Sukantha</creatorcontrib><creatorcontrib>de St. Maurice, Annabelle</creatorcontrib><creatorcontrib>Kanatani, Meganne</creatorcontrib><creatorcontrib>Curello, Jennifer</creatorcontrib><creatorcontrib>Arias, Rubi</creatorcontrib><creatorcontrib>Swearingen, William</creatorcontrib><creatorcontrib>Doernberg, Sarah B</creatorcontrib><creatorcontrib>Patel, Robin</creatorcontrib><title>Randomized Trial Evaluating Clinical Impact of RAPid IDentification and Susceptibility Testing for Gram-negative Bacteremia: RAPIDS-GN</title><title>Clinical infectious diseases</title><description>BACKGROUNDRapid blood culture diagnostics are of unclear benefit for patients with gram-negative bacilli (GNB) bloodstream infections (BSIs). We conducted a multicenter, randomized, controlled trial comparing outcomes of patients with GNB BSIs who had blood culture testing with standard-of-care (SOC) culture and antimicrobial susceptibility testing (AST) vs rapid organism identification (ID) and phenotypic AST using the Accelerate Pheno System (RAPID). METHODSPatients with positive blood cultures with Gram stains showing GNB were randomized to SOC testing with antimicrobial stewardship (AS) review or RAPID with AS. The primary outcome was time to first antibiotic modification within 72 hours of randomization. RESULTSOf 500 randomized patients, 448 were included (226 SOC, 222 RAPID). Mean (standard deviation) time to results was faster for RAPID than SOC for organism ID (2.7 [1.2] vs 11.7 [10.5] hours; P < .001) and AST (13.5 [56] vs 44.9 [12.1] hours; P < .001). Median (interquartile range [IQR]) time to first antibiotic modification was faster in the RAPID arm vs the SOC arm for overall antibiotics (8.6 [2.6-27.6] vs 14.9 [3.3-41.1] hours; P = .02) and gram-negative antibiotics (17.3 [4.9-72] vs 42.1 [10.1-72] hours; P < .001). Median (IQR) time to antibiotic escalation was faster in the RAPID arm vs the SOC arm for antimicrobial-resistant BSIs (18.4 [5.8-72] vs 61.7 [30.4-72] hours; P = .01). There were no differences between the arms in patient outcomes. CONCLUSIONSRapid organism ID and phenotypic AST led to faster changes in antibiotic therapy for gram-negative BSIs. CLINICAL TRIALS REGISTRATIONNCT03218397.</description><subject>Online Only</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNpVkV1LHDEYhUOx1I_2yj-Qy4KMzcckk3hRsKtuF0SLbq9DNh_rKzOTbWZmQX-Av9tYl0IvXvKSc_KEw0HomJJTSjT_5sCXsVYw9QEdUMGbSgpN98pOhKpqxdU-OhyGR0IoVUR8Qvuc8aZWjB2glzvb-9TBc_B4mcG2-HJr28mO0K_xrIUeXLlbdBvrRpwivjv_BR4vLkI_QizaCKnHBYHvp8GFzQgraGF8wssw_EXElPE8267qw7qYtwH_KKSQQwf27I22uLiv5jef0cdo2yF82Z1H6PfV5XL2s7q-nS9m59eV40KNlV5xKqPWWtCoqHReyyCZJlIJUROnLeXcE8ajtLKOTBItJY8rH2uvmvKYH6Hv79zNtOqCdyVGtq3ZZOhsfjLJgvlf6eHBrNPWKFbLRpMC-LoD5PRnKiFNByV429o-pGkwjGuteCNEU6wn71aX0zDkEP99Q4l5a86U5syuOf4KlfiM3Q</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Banerjee, Ritu</creator><creator>Komarow, Lauren</creator><creator>Virk, Abinash</creator><creator>Rajapakse, Nipunie</creator><creator>Schuetz, Audrey N</creator><creator>Dylla, Brenda</creator><creator>Earley, Michelle</creator><creator>Lok, Judith</creator><creator>Kohner, Peggy</creator><creator>Ihde, Sherry</creator><creator>Cole, Nicolynn</creator><creator>Hines, Lisa</creator><creator>Reed, Katelyn</creator><creator>Garner, Omai B</creator><creator>Chandrasekaran, Sukantha</creator><creator>de St. Maurice, Annabelle</creator><creator>Kanatani, Meganne</creator><creator>Curello, Jennifer</creator><creator>Arias, Rubi</creator><creator>Swearingen, William</creator><creator>Doernberg, Sarah B</creator><creator>Patel, Robin</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210701</creationdate><title>Randomized Trial Evaluating Clinical Impact of RAPid IDentification and Susceptibility Testing for Gram-negative Bacteremia: RAPIDS-GN</title><author>Banerjee, Ritu ; Komarow, Lauren ; Virk, Abinash ; Rajapakse, Nipunie ; Schuetz, Audrey N ; Dylla, Brenda ; Earley, Michelle ; Lok, Judith ; Kohner, Peggy ; Ihde, Sherry ; Cole, Nicolynn ; Hines, Lisa ; Reed, Katelyn ; Garner, Omai B ; Chandrasekaran, Sukantha ; de St. Maurice, Annabelle ; Kanatani, Meganne ; Curello, Jennifer ; Arias, Rubi ; Swearingen, William ; Doernberg, Sarah B ; Patel, Robin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c358t-9b316f99951f816cd96e6290685540c9a133d023f6a64f2609663fbdf4d879b33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Online Only</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Banerjee, Ritu</creatorcontrib><creatorcontrib>Komarow, Lauren</creatorcontrib><creatorcontrib>Virk, Abinash</creatorcontrib><creatorcontrib>Rajapakse, Nipunie</creatorcontrib><creatorcontrib>Schuetz, Audrey N</creatorcontrib><creatorcontrib>Dylla, Brenda</creatorcontrib><creatorcontrib>Earley, Michelle</creatorcontrib><creatorcontrib>Lok, Judith</creatorcontrib><creatorcontrib>Kohner, Peggy</creatorcontrib><creatorcontrib>Ihde, Sherry</creatorcontrib><creatorcontrib>Cole, Nicolynn</creatorcontrib><creatorcontrib>Hines, Lisa</creatorcontrib><creatorcontrib>Reed, Katelyn</creatorcontrib><creatorcontrib>Garner, Omai B</creatorcontrib><creatorcontrib>Chandrasekaran, Sukantha</creatorcontrib><creatorcontrib>de St. Maurice, Annabelle</creatorcontrib><creatorcontrib>Kanatani, Meganne</creatorcontrib><creatorcontrib>Curello, Jennifer</creatorcontrib><creatorcontrib>Arias, Rubi</creatorcontrib><creatorcontrib>Swearingen, William</creatorcontrib><creatorcontrib>Doernberg, Sarah B</creatorcontrib><creatorcontrib>Patel, Robin</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Banerjee, Ritu</au><au>Komarow, Lauren</au><au>Virk, Abinash</au><au>Rajapakse, Nipunie</au><au>Schuetz, Audrey N</au><au>Dylla, Brenda</au><au>Earley, Michelle</au><au>Lok, Judith</au><au>Kohner, Peggy</au><au>Ihde, Sherry</au><au>Cole, Nicolynn</au><au>Hines, Lisa</au><au>Reed, Katelyn</au><au>Garner, Omai B</au><au>Chandrasekaran, Sukantha</au><au>de St. Maurice, Annabelle</au><au>Kanatani, Meganne</au><au>Curello, Jennifer</au><au>Arias, Rubi</au><au>Swearingen, William</au><au>Doernberg, Sarah B</au><au>Patel, Robin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Randomized Trial Evaluating Clinical Impact of RAPid IDentification and Susceptibility Testing for Gram-negative Bacteremia: RAPIDS-GN</atitle><jtitle>Clinical infectious diseases</jtitle><date>2021-07-01</date><risdate>2021</risdate><volume>73</volume><issue>1</issue><spage>e39</spage><epage>e46</epage><pages>e39-e46</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>BACKGROUNDRapid blood culture diagnostics are of unclear benefit for patients with gram-negative bacilli (GNB) bloodstream infections (BSIs). We conducted a multicenter, randomized, controlled trial comparing outcomes of patients with GNB BSIs who had blood culture testing with standard-of-care (SOC) culture and antimicrobial susceptibility testing (AST) vs rapid organism identification (ID) and phenotypic AST using the Accelerate Pheno System (RAPID). METHODSPatients with positive blood cultures with Gram stains showing GNB were randomized to SOC testing with antimicrobial stewardship (AS) review or RAPID with AS. The primary outcome was time to first antibiotic modification within 72 hours of randomization. RESULTSOf 500 randomized patients, 448 were included (226 SOC, 222 RAPID). Mean (standard deviation) time to results was faster for RAPID than SOC for organism ID (2.7 [1.2] vs 11.7 [10.5] hours; P < .001) and AST (13.5 [56] vs 44.9 [12.1] hours; P < .001). Median (interquartile range [IQR]) time to first antibiotic modification was faster in the RAPID arm vs the SOC arm for overall antibiotics (8.6 [2.6-27.6] vs 14.9 [3.3-41.1] hours; P = .02) and gram-negative antibiotics (17.3 [4.9-72] vs 42.1 [10.1-72] hours; P < .001). Median (IQR) time to antibiotic escalation was faster in the RAPID arm vs the SOC arm for antimicrobial-resistant BSIs (18.4 [5.8-72] vs 61.7 [30.4-72] hours; P = .01). There were no differences between the arms in patient outcomes. CONCLUSIONSRapid organism ID and phenotypic AST led to faster changes in antibiotic therapy for gram-negative BSIs. CLINICAL TRIALS REGISTRATIONNCT03218397.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>32374822</pmid><doi>10.1093/cid/ciaa528</doi><oa>free_for_read</oa></addata></record> |
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| source | Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
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| title | Randomized Trial Evaluating Clinical Impact of RAPid IDentification and Susceptibility Testing for Gram-negative Bacteremia: RAPIDS-GN |
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