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RDTs decrease risk for mortality from bloodstream infections
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Molecular rapid diagnostic testing decreases the risk for mortality in patients with bloodstream infections, and it may be particularly useful against resistant organisms, according to a meta-analysis published in Clinical Infectious Diseases.
Molecular rapid diagnostic testing (mRDT) has improved upon conventional microbiological methods, but its effectiveness for improving outcomes for patients with bloodstream infections (BSIs) had not been consistently demonstrated.
“The objective of this systematic review and meta-analysis was to provide a comprehensive and up-to-date assessment of mRDT on mortality, time to effective therapy, and [length of stay (LOS)], when compared to conventional microbiology methods in patients with BSIs,” Kerry L. LaPlante, PharmD, FCCP, professor at the University of Rhode Island, College of Pharmacy, and colleagues wrote.
The researchers searched PubMed, CINAHL, Web of Science and EMBASE through May for studies comparing clinical outcomes by mRDT and conventional microbiology methods for patients with BSIs. They identified 31 studies that met their inclusion criteria and, from those studies, extracted data on 5,920 patients. To put the effect of these tests in clinical terms, LaPlante and colleagues calculated the number needed to treat (NNT) to prevent one death.
All but two studies took place in academic medical centers, and of the 21 studies reporting patient information, 20 involved adults. Gram-positive organisms were examined in 17 studies, compared with gram-negatives in seven studies, multiple organisms in five studies and yeast in two studies. Twenty of the 31 studies reported an antimicrobial stewardship program (ASP) facilitating mRDT.
LaPlante and colleagues found that, overall, the risk for mortality was significantly lower with mRDT than with conventional microbiology methods (OR = 0.66; 95% CI, 0.54-0.8), resulting in an NNT of 20.
Notably, however, the lowered risk for mortality was only significant with mRDT in studies with ASPs (OR = 0.64; 95% CI, 0.51-0.79). Studies without ASPs failed to demonstrate a significant decrease in mortality risk (OR = 0.72; 95% CI, 0.46-1.12).
Further, significant decreases in mortality risk were found with both gram-positive (OR= 0.73; 95% CI, 0.55-0.97), gram-negative (OR= 0.51; 95% CI, 0.33-0.78) and multiple organism (OR = 0.58; 95% CI, 0.32-1.04) testing with mRDT, but not yeast (OR= 0.9; 95% CI, 0.49-1.67).
Significant decreases were found in both time to effective therapy and LOS with mRDT. Time to effective therapy — defined as the time from either blood specimen obtainment or a positive test to a therapy with in vitro activity against the infecting organism — decreased with mRDT by a weighted mean difference of –5.03 hours (95% CI, –8.6 to –1.45). LOS decreased by –2.48 days (95% CI, –3.9 to –1.06).
“The greatest benefit of mRDT for improving time to effective therapy may be for BSIs caused by resistant organisms, particularly [vancomycin-resistant enterococci (VRE)],” the researchers concluded. “Additional studies in community hospitals are needed, as are additional studies elucidating the benefits of various microbiologic technologies in combination with ASP to define best practices.” – by Sarah Kennedy
Disclosure: LaPlante reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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