Diagnostics
efficient antibiotics treatment, 125/183 patients (68.3%) were impacted by the early receipt of the identification of the pathogen; 58/183 (31.7%) were unchanged. “As we were able to get the result on time, our
microbiologist could advise the medical team on what to do in terms of source control (Fig 3). The top three sources were urinary, biliary and skin,” commented Olubunmi. “Because of the
1800 1600 1400 1200 1000 800 600 400 200 0
improved process, we were able to carry out 49 investigations following the use of BioFire, which was really important.” The type of interventions included
echocardiogram, removal of line, removal of urinary catheter, CT (abdominal pelvis/KUB), MRI and a variety of others. The pilot also established the impact on the duration of antibiotics and length of stay. Length of stay corresponded
with the duration on antibiotics – one day less on antibiotics results in a two-day reduction in length of stay, Olubunmi explained. The hospital also found it was able to de-
January February BioFire BCID (mins) March April May Laboratory MALDI-ToF TAT (mins) Fig 1. Improved turnaround time (TAT) - sample collection to pathogen identification Month Patient ID BioFire ID result Lab ID result January 415010 3027630
February 1397613 March
1435262 9507075
Comment
False ID laboratory A re-test by Lab method confirmed
Bacteroids fragilis Streptococcus constellatus BioFire result None None None None
Rhizobium radiobacter Klebsiella pneumoniae Actinotignum sanguinis Bacillus cereus
Non Panel Pathogen False negative BioFire Non Panel Pathogen Non Panel Pathogen
1095200 Streptococcus spp. None 1662626 1621240
None None
False negative Laboratory based on clinical symptoms. Patient treated based on BioFire, recovered and discharged
Clostridium perfringens Fig 2. High level of agreement between methods
45 40 35 30 25 20 15 10 5 0
Non Panel Pathogen Coagulase Negative Staph. False negative BioFire
escalate and stop antibiotics in patients where appropriate, based on the findings from the BioFire tests. This saved money and achieved better antibiotic stewardship (Fig 4). In addition, the technology assisted escalation of patient care – 27/183 (14.8%) bacteraemic patients were escalated and required level 2/3 care. In terms of the impact on patient outcomes, 31/183 passed away – which represented a mortality rate of 16.9%. Olubunmi stated that while all those involved with patient care would wish for mortality to be zero, this result was lower than it would have been if they hadn’t received the results on time. The pilot findings showed that 120/183 patients were discharged (66.5%); 18 were readmitted within 30 days (15%), but only seven (5.8%) were due to infection. The pilot also looked at three primary metrics for measuring performance, and the results were as follows: l Reduction in time to identify pathogen compared to routine care: The study showed a significant reduction in time to pathogen identification, with an average time saving of 17 hours per patient sample compared to sending sample to the main laboratory.
l Reduction in time to antibiotic therapy (improved management and outcome): Patients were on targeted treatment within 13 hours, but this improved significantly to approximately three hours for April and May (as the BioFire process became embedded within Blood Sciences).
l Contamination rate of <3% (reduced wastage): This was not completely achieved. The ambitious target of <3% was met in two out of six months of the pilot giving an overall median of 3.45% and a mean of 3.63%. (For context, the overall Berkshire and Surrey Pathology Services contamination rate was >4%)
“This was an ambitious contamination rate target. We are part of a network and we looked at the other hospital sites; we are actually doing very well in comparison. It was met in some months but not others, due to a slow start for funding and some staffing issues…However, our CEO and execs are happy with what has been achieved,” Olubunmi commented.
Fig 3. Source of infection 42
www.clinicalservicesjournal.com I January 2024
Success stories She concluded her presentation with three success stories – including the rapid detection of invasive Group Strep A in a patient with severe sepsis; the rapid detection of antibiotic resistance in a patient with
Urinary Other
Unknown Biliary Skin
Abdominal Chest CAUTI Line
Cellulitis
Infective endocarditis Abcess
Leg ulcers Pyelonephritis CAP
Contaminant
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