[en] [en] INTRODUCTION: Sepsis is an important cause of morbidity and mortality. An accelerated microbiology diagnosis is crucial in order to reduce the time to initiate targeted antibiotic therapy. The Alfred60AST system is able to provide phenotypic Antimicrobial Susceptibility Testing (AST) results within hours. This study has two objectives: assess the clinical impact of this technology and determine its cost-effectiveness.
METHODS: During a ten-week period, all new enterobacterial or enterococcal bloodstream infection was analyzed with the Alfred60AST system, in parallel with routine methods. Its impact on the clinician's therapeutic strategy was studied. In order to assess the financial and practical aspects of the method, an analysis of the extracosts and a survey of the technical staff were conducted.
RESULTS: Fifty-three cases of bacteriemia were included. For the Enterobacteriaceae bacteriemias, a clinical impact was shown in 18.9% of the cases (e.g, treatment modification). The financial analysis highlighted an increase in costs (+38% for Enterobacteriaceae, +50% for Enterococci), compared to the theoretical costs reported by the firm, due to the workflow and the volumes of samples used. Finally, results of the technical staff survey were favorable in terms of ease of use of the system.
CONCLUSION: In addition to its ease of use, the Alfred60AST system is able to provide an AST in a record time. This study shows a real interest of the technique in the therapeutic management of patients with enterobacterial sepsis. However, its routine implementation requires an increase of the analyzed volumes as well as a 24/7 organization of the laboratory in order to be profitable.
Disciplines :
Laboratory medicine & medical technology
Author, co-author :
Potvin, M; Microbiology Department, LHUB-ULB, rue haute, 322, 1000 Brussels, Belgium. Electronic address: manon.potvin@lhub-ulb.be
Larranaga Lapique, E; Department of Infectious Disease, Erasme Hospital, route de Lennik, 808, 1070 Brussels, Belgium
Hites, M; Department of Infectious Disease, Erasme Hospital, route de Lennik, 808, 1070 Brussels, Belgium
Martiny, Delphine ; Université de Mons - UMONS ; Microbiology Department, LHUB-ULB, rue haute, 322, 1000 Brussels, Belgium
Language :
English
Title :
Implementing Alfred60AST in a clinical lab: Clinical impact on the management of septic patients and financial analysis.
Perner, A., Gordon, A.C., De Backer, D., Dimopoulos, G., Russell, J.A., Lipman, J., et al. Sepsis: frontiers in diagnosis, resuscitation and antibiotic therapy. Intensive Care Med 42:12 (2016), 1958–1969.
Giordano, C., Piccoli, E., Brucculeri, V., Barnini, S., A prospective evaluation of two rapid phenotypical antimicrobial susceptibility technologies for the diagnostic stewardship of sepsis. Biomed Res Int, 2018, 2018, 6976923.
Alberti, C., Brun-Buisson, C., Burchardi, H., Martin, C., Goodman, S., Artigas, A., et al. Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med 28:2 (2002), 108–121.
Martin, G.S., Mannino, D.M., Eaton, S., Moss, M., The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348:16 (2003), 1546–1554.
Christner, M., Rohde, H., Wolters, M., Sobottka, I., Wegscheider, K., Aepfelbacher, M., Rapid identification of bacteria from positive blood culture bottles by use of matrix-assisted laser desorption-ionization time of flight mass spectrometry fingerprinting. J Clin Microbiol 48:5 (2010), 1584–1591.
Bauer, K.A., Perez, K.K., Forrest, G.N., Goff, D.A., Review of rapid diagnostic tests used by antimicrobial stewardship programs. Clin Infect Dis 59:Suppl 3 (2014), S134–S145.
Kumar, A., Roberts, D., Wood, K.E., Light, B., Parrillo, J.E., Sharma, S., et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34:6 (2006), 1589–1596.
Rhodes, A., Evans, L.E., Alhazzani, W., Levy, M.M., Antonelli, M., Ferrer, R., et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43:3 (2017), 304–377.
Martínez, M.L., Plata-Menchaca, E.P., Ruiz-Rodríguez, J.C., Ferrer, R., An approach to antibiotic treatment in patients with sepsis. J Thorac Dis 12:3 (2020), 1007–1021.
Vazquez-Guillamet, C., Scolari, M., Zilberberg, M.D., Shorr, A.F., Micek, S.T., Kollef, M., Using the number needed to treat to assess appropriate antimicrobial therapy as a determinant of outcome in severe sepsis and septic shock. Crit Care Med 42:11 (2014), 2342–2349.
Allison, M.G., Heil, E.L., Hayes, B.D., Appropriate antibiotic therapy. Emerg Med Clin North Am 35:1 (2017), 25–42.
Candel, F.J., Borges Sá, M., Belda, S., Bou, G., Del Pozo, J.L., Estrada, O., et al. Current aspects in sepsis approach. Turning things around. Rev Esp Quimioter 31:4 (2018), 298–315.
Inglis, T.J.J., Ekelund, O., Rapid antimicrobial susceptibility tests for sepsis; the road ahead. J Med Microbiol 68:7 (2019), 973–977.
Sánchez-Carrillo, C., Pescador, P., Ricote, R., Fuentes, J., Losada, C., Candela, A., et al. Evaluation of the Alfred AST® system for rapid antimicrobial susceptibility testing directly from positive blood cultures. Eur J Clin Microbiol Infect Dis 38:9 (2019), 1665–1670.
Martiny, D., Debaugnies, F., Gateff, D., Gérard, M., Aoun, M., Martin, C., et al. Impact of rapid microbial identification directly from positive blood cultures using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry on patient management. Clin Microbiol Infect 19:12 (2013), E568–E581.
Cohen, J., Vincent, J.L., Adhikari, N.K., Machado, F.R., Angus, D.C., Calandra, T., et al. Sepsis: a roadmap for future research. Lancet Infect Dis 15:5 (2015), 581–614.
Zhou, X., Su, L.X., Zhang, J.H., Liu, D.W., Long, Y., Rules of anti-infection therapy for sepsis and septic shock. Chin Med J (Engl) 132:5 (2019), 589–596.
Maugeri, G., Lychko, I., Sobral, R., Roque, A.C.A., Identification and antibiotic-susceptibility profiling of infectious bacterial agents: a review of current and future trends. Biotechnol J, 14(1), 2019, e1700750.
Banerjee, R., Komarow, L., Virk, A., Rajapakse, N., Schuetz, A.N., Dylla, B., et al. Randomized Trial evaluating clinical impact of rapid identification and susceptibility testing for gram-negative bacteremia: RAPIDS-GN. Clin Infect Dis 73:1 (2021), e39–e46.
Van den Poel, B., Meersseman, P., Debaveye, Y., Klak, A., Verhaegen, J., Desmet, S., Performance and potential clinical impact of Alfred60AST(Alifax®) for direct antimicrobial susceptibility testing on positive blood culture bottles. Eur J Clin Microbiol Infect Dis 39:1 (2020), 53–63.
Anton-Vazquez, V., Adjepong, S., Suarez, C., Planche, T., Evaluation of a new Rapid Antimicrobial Susceptibility system for Gram-negative and Gram-positive bloodstream infections: speed and accuracy of Alfred 60AST. BMC Microbiol, 19(1), 2019, 268.
Boland, L., Streel, C., De Wolf, H., Rodriguez, H., Verroken, A., Rapid antimicrobial susceptibility testing on positive blood cultures through an innovative light scattering technology: performances and turnaround time evaluation. BMC Infect Dis, 19(1), 2019, 989.
Cupaiolo, R., Cherkaoui, S., Serrano, G., Dauby, N., Georgala, A., Blumental, S., et al. Antimicrobial susceptibility testing determined by Alfred 60/AST (Alifax®) in a multi-sites lab: performance's evaluation and optimization of workflow. J Microbiol Methods, 194, 2022, 106433.
Sader, H.S., Fritsche, T.R., Jones, R.N., Accuracy of three automated systems (MicroScan WalkAway, VITEK, and VITEK 2) for susceptibility testing of Pseudomonas aeruginosa against five broad-spectrum beta-lactam agents. J Clin Microbiol 44:3 (2006), 1101–1104.
Dare, R.K., Lusardi, K., Pearson, C., McCain, K.D., Daniels, K.B., Van, S., et al. Clinical impact of accelerate pheno rapid blood culture detection system in bacteremic patients. Clin Infect Dis 73:11 (2021), e4616–e4626.
Robinson, E.D., Stilwell, A.M., Attai, A.E., Donohue, L.E., Shah, M.D., Hill, B.K., et al. Implementation of a rapid phenotypic susceptibility platform for gram-negative bloodstream infections with paired antimicrobial stewardship intervention: is the juice worth the squeeze?. Clin Infect Dis 73:5 (2021), 783–792.
Ehren, K., Meißner, A., Jazmati, N., Wille, J., Jung, N., Vehreschild, J.J., et al. 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. Clin Infect Dis 70:7 (2020), 1285–1293.
Giacobbe, D.R., Giani, T., Bassetti, M., Marchese, A., Viscoli, C., Rossolini, G.M., Rapid microbiological tests for bloodstream infections due to multidrug resistant Gram-negative bacteria: therapeutic implications. Clin Microbiol Infect 26:6 (2020), 713–722.
Hogan, C.A., Ebunji, B., Watz, N., Kapphahn, K., Rigdon, J., Mui, E., et al. Impact of rapid antimicrobial susceptibility testing in gram-negative rod bacteremia: a quasi-experimental study. J Clin Microbiol 58:9 (2020), e00360–e420.
Eveillard, M., Lemarié, C., Cottin, J., Hitoto, H., Mahaza, C., Kempf, M., et al. Assessment of the usefulness of performing bacterial identification and antimicrobial susceptibility testing 24h a day in a clinical microbiology laboratory. Clin Microbiol Infect 16:8 (2010), 1084–1089.
Idelevich, E.A., Becker, K., How to accelerate antimicrobial susceptibility testing. Clin Microbiol Infect 25:11 (2019), 1347–1355.
Patel, T.S., Kaakeh, R., Nagel, J.L., Newton, D.W., Stevenson, J.G., Cost analysis of implementing matrix-assisted laser desorption ionization-time of flight mass spectrometry plus real-time antimicrobial stewardship intervention for bloodstream infections. J Clin Microbiol 55:1 (2016), 60–67.
Tran, A., Alby, K., Kerr, A., Jones, M., Gilligan, P.H., Cost savings realized by implementation of routine microbiological identification by matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol 53:8 (2015), 2473–2479.
Tan, K.E., Ellis, B.C., Lee, R., Stamper, P.D., Zhang, S.X., Carroll, K.C., Prospective evaluation of a matrix-assisted laser desorption ionization-time of flight mass spectrometry system in a hospital clinical microbiology laboratory for identification of bacteria and yeasts: a bench-by-bench study for assessing the impact on time to identification and cost-effectiveness. J Clin Microbiol 50:10 (2012), 3301–3308.
Charnot-Katsikas, A., Tesic, V., Love, N., Hill, B., Bethel, C., Boonlayangoor, S., et al. Use of the accelerate pheno system for identification and antimicrobial susceptibility testing of pathogens in positive blood cultures and impact on time to results and workflow. J Clin Microbiol 56:1 (2017), e01166–e1217.
Deresinski, S., Principles of antibiotic therapy in severe infections: optimizing the therapeutic approach by use of laboratory and clinical data. Clin Infect Dis 45 Suppl 3 (2007), S177–S183.
