BLOOD CULTURE


study using the ASTar platform in the Basingstoke and North Hampshire Hospital showed the use of a rapid identification and AST in 57 patients resulted in: 14 optimisations of treatment; five reductions of antibiotic; nine cases where the spectrum of antibiotic use could be reduced; and interestingly the rapid results enabled seven infection- control interventions resulting in possible reduction in nosocomial spread.14 We know the performance of these platforms are now proven and implementation will enable us to move away from the age-old labour-intensive agar methods when sepsis is indicated. However, in my humble opinion, one of the main barriers to implementing rapid AST solutions is the cost per test. When this is looked at with tunnel vision and in comparison, with an agar plate, antibiotic disks, and incubator; then of course the manual way is cheaper. However, this does not consider: the time to result; staffing skill mix changes you can make; and more importantly the savings that can be made across the wider hospital. A holistic view where healthcare economy in its entirety should be considered. For a business case to get past the finance director, it should not be based solely on the microbiology costs and must bring in the health and financial benefits across the whole of the hospital’s healthcare economy. We all know what happens when money is put ahead of evidence- based healthcare, Mr Sunak clearly showed us that with his ‘Eat out to help out’ strategy during the recent pandemic! In conclusion these platforms are not a cheap solution and should be targeted in their use within the microbiology laboratory. As I have already indicated the overall cost to the healthcare economy and enhanced patient care are proven, and rather than asking, ‘how can the microbiology laboratory can afford them?’ you should be asking, ‘how can the hospital afford not to implement them?’


References 1 Geroulanos S, Douka ET. Historical


perspective of the word “sepsis”. Intensive Care Med. 2006;32(12):2077. doi:10.1007/ s00134-006-0392-2


2 Rudd KE, Johnson SC, Agesa KM et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200-211. doi:10.1016/S0140-6736(19)32989-7


3 UK Sepsis Trust. References and Sources. 2018 (https://sepsistrust.org/about/about- sepsis/references-and-sources)


4 Ferrer R, Martin-Loeches I, Phillips G et al. Empiric antibiotic treatment reduces mortality in severe sepsis and


The beneficial clinical impact of platforms offering AST analysis for patients with suspected sepsis is clear to see, with the ASTar instrument performing well in a recent study carried out at Basingstoke and North Hampshire Hospital.


septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med. 2014;42(8):1749-1755. doi:10.1097/ CCM.0000000000000330


5 Retamar P, Portillo MM, López-Prieto MD et al. Impact of inadequate empirical therapy on the mortality of patients with bloodstream infections: a propensity score-based analysis. Antimicrob Agents Chemother. 2012;56(1):472-478. doi:10.1128/AAC.00462-11


6 O’Neill J. The Review on Antimicrobial Resistance. HM Government 2016 (www. amr-review.org)


7 Bae EY, Smith TT, Monogue ML. A case- control study evaluating the unnecessary use of intravenous broad-spectrum antibiotics in presumed sepsis and septic-shock patients in the emergency department. Antimicrob Steward Healthc Epidemiol. 2022;2(1):e193. Published 2022 Dec 6. doi:10.1017/ash.2022.341


8 Marquet K, Liesenborgs A, Bergs J, Vleugels A, Claes N. Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis. Crit Care. 2015;19(1):63. Published 2015 Feb 16. doi:10.1186/s13054-015-0795-y


9 Zilberberg MD, Nathanson BH, Sulham K, Fan W, Shorr AF. 30-day readmission, antibiotics costs and costs of delay to adequate treatment of Enterobacteriaceae UTI, pneumonia, and sepsis: a retrospective cohort study. Antimicrob Resist Infect Control. 2017;6:124. Published 2017 Dec 6. doi:10.1186/ s13756-017-0286-9


10 Shorr AF, Micek ST, Welch EC, Doherty JA, Reichley RM, Kollef MH. Inappropriate antibiotic therapy in Gram-negative sepsis increases hospital length of stay. Crit Care Med. 2011;39(1):46-51. doi:10.1097/ CCM.0b013e3181fa41a7


WWW.PATHOLOGYINPRACTICE.COM FEBRUARY 2024


11 Roberts JA, Abdul-Aziz MH, Lipman J et al. Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions. Lancet Infect Dis. 2014;14(6):498-509. doi:10.1016/S1473- 3099(14)70036-2


12 World Health Organization. WHO publishes list of bacteria for which new antibiotics are urgently needed. WHO 2017 (https://www.who.int/news/item/27- 02-2017-who-publishes-list-of-bacteria- for-which-new-antibiotics-are-urgently- needed)


13 Berinson B, Olearo F, Both A et al. EUCAST rapid antimicrobial susceptibility testing (RAST): analytical performance and impact on patient management. J Antimicrob Chemother. 2021;76(5): 1332-1338. doi:10.1093/jac/dkab026


14 Kidd S. Presentation on the impact of rapid AST in the clinical setting. IBMS Congress 2023.


Dr (hc) Neil Bentley OBE is an experienced biomedical scientist with over 40 years of science, management, and leadership experience within the field of pathology and public health. In a 25-year career with Public Health England (PHE) he was most recently Deputy Director Pathogen Genomics- COVID Programme until October 2022, previously he was Head of Specialist Microbiology Technical Services at PHE’s National Infection Service. He is currently Scientific Officer at Pro-Lab Diagnostics.


Pro-Lab Diagnostics The Q-linea ASTar instrument and consumables are available in the UK from Pro-Lab Diagnostics. 0151 353 1613 uksupport@pro-lab.com www.pro-lab.co.uk


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