Impact of EUCAST rapid antimicrobial susceptibility testing (RAST) on management of Gram-negative bloodstream infection - 20/11/22
, Marie Alice Colombier b, Lucie Limousin a, Orianne Daude a, Oscar Izarn a, Pierre Cahen a, Eric Farfour a, Philippe Lesprit c, Marc Vasse aHighlights |
• | Rapid antimicrobial testing (RAST) can be used routinely to rapidly detect resistant Gram-negative strains isolated from blood cultures. |
• | RAST significantly increases the number of patients with effective antibiotic therapy on the day of positive blood culture. |
• | RAST occasions antibiotic de-escalation on the day of positive blood culture. |
Abstract |
Objectives |
During bloodstream infections, reducing the time to antimicrobial susceptibility testing is crucial to initiation of early appropriate antibiotic therapy. For Gram-negative infections, a phenotypic approach remains necessary. Rapid antimicrobial testing (RAST) is a recently developed phenotypic EUCAST method. The goal of this study was to evaluate the accuracy and clinical impact of RAST.
Patients and methods |
From September 2020 to August 2021, Gram-negative episodes with positive blood culture detected in the morning were included in the RAST group. Categorical agreement of RAST with conventional antimicrobial testing on strains was determined. To assess antibiotic management and patient outcomes, the RAST group was compared with a control group (CG) with positive blood culture detected in the afternoon for which overnight antimicrobial testing was performed.
Results |
The RAST group included 61 episodes from 61 patients, while the CG group included 49 episodes from 48 patients. While RAST performed on 41 E. coli, 11 K. pneumoniae and 9 P. aeruginosa strains highlighted 99.3 % of categorical agreement, 7.4 % of unreadable zones and 9.4 % of technical uncertainty area at 4 h incubation were also reported.
For the RAST group, effective antibiotic therapy was prescribed in 100 % of patients on the day of positive blood culture (day 1) vs 88 % in CG (p = 0,007). As for beta-lactams on day 1, RAST led to 9 escalations and 6 de-escalations. Mortality and length of hospital stay did not significantly differ between the two groups.
Conclusion |
RAST improves management of antibiotic therapy in patients with Gram-negative sepsis.
Le texte complet de cet article est disponible en PDF.Keywords : Bloodstream infection, Rapid antimicrobial susceptibility testing, RAST, Antibiotics
Plan
Vol 52 - N° 8
P. 421-425 - novembre 2022 Retour au numéro
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