By Gina Shaw
Implementation of the BioFire FilmArray Blood Culture Identification 2 (BCID2; bioMérieux) panel significantly reduced time to effective therapy for bloodstream infections (BSIs) with resistant organisms, in a single-center retrospective study. The findings were presented by investigators from NYU Langone Health, in New York City, at the Making a Difference in Infectious Disease (MAD-ID) conference in Orlando, Fla.
“Limited literature describes the impact of the BCID2 panel on clinical outcomes in patients with organisms not covered by typical empiric regimens,” noted presenting author Yihan Li, PharmD, a PGY-2 infectious diseases pharmacy resident. “We had implemented the panel in 2022, and as it is a fairly costly test, we wanted to examine the impact of utilization on time to effective therapy and patient-level outcomes, particularly in resistant organisms not covered by empiric sepsis therapies.”
The retrospective review compared adults with extended-spectrum beta-lactamase (ESBL)- or AmpC- producing Enterobacterales, Acinetobacter baumannii, Stenotrophomonas maltophilia or Enterococcus species BSIs before (July 2020 to December 2021) and after (July 2022 to December 2023) BCID2 implementation. It included 319 patients: 128 from the pre-BCID2 period and 191 from the post-BCID2 period. The primary outcome was time from positive result to initiation of effective therapy. Clinical outcomes included recurrence, readmission, development of resistance, Clostridioides difficile infection and 30-day mortality.
“Most of the patients in both groups had ESBL infections, followed by Enterococcus and AmpC,” Dr. Li said. “Initial antibiotics were most commonly vancomycin, followed by piperacillin-tazobactam.”
Overall, time to effective therapy decreased from seven hours to four hours after implementation of the BCID2 panel (P=0.011), and most of the improvement was due to a dramatic reduction in time to effective therapy for gram-negative rods from 41 hours to six hours (P=0.001). Clinically significant differences were also seen in the Enterococcus faecium and vancomycin-resistant enterococci subgroups, but empiric regimens were largely effective against E. faecalis infections.
The team’s antimicrobial stewardship pharmacists also performed more interventions prior to test results in the post-BCID2 group than the pre-BCID2 one (39% vs. 22%; P=0.002). “These included antimicrobial escalation, drug−bug mismatch/alternative therapy, initiation of new therapy, specialist consultation and approval of restricted medication,” Dr. Li said.
However, statistically significant differences were not observed in patient outcomes, including hospital length of stay, 30-day recurrence of bacteremia infection with the same organism, 30-day remission for infection-related reasons, and death for any cause or for bacteremia-related reasons within 30 days of positive blood culture. Dr. Li noted that this result might be due to overall low event rates and a smaller critically ill population. “Future studies with larger populations are needed to more clearly assess outcomes,” she said.
Dr. Li reported no relevant financial disclosures.
