Amy Kruger Howard, PGY2

University of Maryland School of Pharmacy, Baltimore, Maryland

Objectives: 

Describe the role of rapid diagnostic testing in patients with a suspected blood stream infection

Choose an appropriate antibiotic therapy in the case of a known bacteremia guided by rapid diagnostic testing results and treatment algorithm recommendations

Abstract:

Introduction:
Verigene Blood Culture (BC) microarray rapid diagnostic testing (RDT) has been shown to have a specificity and sensitivity greater than 95 percent. Prior studies have shown use of this RDT, in combination with antimicrobial stewardship treatment algorithms, is an effective means of improving antibiotic prescribing in bacteremia - mainly through early identification of antibiotic resistance and appropriate escalation of therapy. Limited clinical experience exists in pediatric patients using this RDT along with a treatment algorithm to systematically tailor therapy. This study aims to validate the use of Verigene BC reported results in pediatric patients to guide clinical practice and allow for antimicrobial therapy optimization to occur earlier in a treatment course. The primary outcome will be to assess the accuracy of all Verigene BC RDT results as compared to final culture results. Secondary outcomes include validation of a pediatric antimicrobial stewardship algorithm (PAMSA) and assessment of the appropriateness of the standard care antibiotics administered based on reported RDT results. We hypothesize a concordance of greater than 90 percent for the RDT and final culture results.

Methods:
This study is a retrospective, single-center, review of all neonatal and pediatric patients (age < 18 years) admitted to Neonatal Intensive Care Unit, Pediatric Intensive Care Unit, or Pediatric Progressive Care Unit with positive blood cultures tested on the Verigene BC RDT from September 2015 through October 2018. Sensitivity and specificity of the Verigene BC RDT will be determined by comparison to traditional clinical microbiology results (Vitek2 MS and/or Kirby Baurer). Appropriateness of antimicrobial therapy will be determined by in vitro susceptibility derived from traditional microbiological methods. Appropriateness of antimicrobials received will be compared to PAMSA recommended antimicrobials to determine accuracy and potential clinical benefit by two independent reviewers. A Cohen’s Kappa statistic will be used for inter-rater reliability and adjudication completed as needed. Descriptive statistics will be reported as mean, median, and confidence interval, as appropriate. Comparisons made between potential treatment therapy with and without the PAMSA will be made using Chi squared or Fisher exact test as appropriate. Continuous data will be analyzed with student t-test or Mann Whitney U, as appropriate.
Results: Results will be submitted within final slides.

Conclusion: Conclusion will be submitted within final slides.

Handout Slides:

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