Research Article | Open Access
The Utility of Rapid Microbiological and Molecular Techniques in Optimizing Antimicrobial Therapy
Early treatment of bloodstream infections with appropriate, definitive antimicrobial therapy has proven to reduce mortality, length of hospital stay, and healthcare costs. Culture-based testing methods require up to five days for final pathogen identification and susceptibility reporting, forcing use of broad spectrum empiric therapy. Recently, multiple rapid microbiological and molecular testing methods have been developed that reduce the time to identify the pathogen and susceptibility, allowing optimal antimicrobial therapy to be prescribed earlier. Real-time polymerase chain reaction and gene microarray have been described in literature, yet only peptide nucleic acid fluorescent in-situ hybridization has published data justifying its use based on clinical outcomes and cost savings. Target enriched multiplex polymerase chain reaction was developed to identify both the pathogen and multiple genes associated with resistance from blood within 6 hours and this methodology was studied in our hospital to assess effectiveness at optimizing antimicrobials in staphylococcal bloodstream infections.
- M. H. Kollef, L. M. Napolitano, J. S. Solomkin et al., “Health care-associated infection (HAI): a critical appraisal of the emerging threat—proceedings of the HAI Summit,” Clinical Infectious Diseases, vol. 47, supplement 2, pp. S55–S99, 2008.
- A. M. Minino and B. L. Smith, Deaths: Preliminary Data for 2000, vol. 49, National Center for Health Statistics, Hyattsville, Md, USA, 2001.
- D. J. Diekema, S. E. Beekmann, K. C. Chapin, K. A. Morel, E. Munson, and G. V. Doern, “Epidemiology and outcome of nosocomial and community-onset bloodstream infection,” Journal of Clinical Microbiology, vol. 41, no. 8, pp. 3655–3660, 2003.
- A. F. Shorr, Y. P. Tabak, A. D. Killian, V. Gupta, L. Z. Liu, and M. H. Kollef, “Healthcare-associated bloodstream infection: a distinct entity? Insights from a large U.S. database,” Critical Care Medicine, vol. 34, no. 10, pp. 2588–2595, 2006.
- S. E. Beekmann, D. J. Diekema, K. C. Chapin, and G. V. Doern, “Effects of rapid detection of bloodstream infections on length of hospitalization and hospital charges,” Journal of Clinical Microbiology, vol. 41, no. 7, pp. 3119–3125, 2003.
- R. Khatib, S. Saeed, M. Sharma, K. Riederer, M. G. Fakih, and L. B. Johnson, “Impact of initial antibiotic choice and delayed appropriate treatment on the outcome of Staphylococcus aureus bacteremia,” European Journal of Clinical Microbiology and Infectious Diseases, vol. 25, no. 3, pp. 181–185, 2006.
- M. Klouche, “Rapid diagnostic tests to detect pathogenic microorganisms,” Clinical Chemistry and Laboratory Medicine, vol. 46, no. 7, pp. 885–887, 2008.
- P. Y. Bochud, M. P. Glauser, J. Carlet, and T. Calandra, “Empirical Antibiotic therapy for patients with severe sepsis and septic shock,” in The Sepsis Text Book, J. L. Vincent, Ed., p. 543, Springer, New York, NY, USA, 2002.
- G. N. Forrest, S. Mehta, E. Weekes, D. P. Lincalis, J. K. Johnson, and R. A. Venezia, “Impact of rapid in situ hybridization testing on coagulase-negative staphylococci positive blood cultures,” Journal of Antimicrobial Chemotherapy, vol. 58, no. 1, pp. 154–158, 2006.
- T. Ly, J. Gulia, V. Pyrgos, M. Waga, and S. Shoham, “Impact upon clinical outcomes of translation of PNA FISH-generated laboratory data from the clinical microbiology bench to bedside in real time,” Therapeutics and Clinical Risk Management, vol. 4, no. 3, pp. 637–640, 2008.
- G. N. Forrest, M.-C. Roghmann, L. S. Toombs et al., “Peptide nucleic acid fluorescent in situ hybridization for hospital-acquired enterococcal bacteremia: delivering earlier effective antimicrobial therapy,” Antimicrobial Agents and Chemotherapy, vol. 52, no. 10, pp. 3558–3563, 2008.
- G. W. Procop, “Molecular diagnostics for the detection and characterization of microbial pathogens,” Clinical Infectious Diseases, vol. 45, supplement 2, pp. S99–S111, 2007.
- F. C. Tenover, “Rapid detection and identification of bacterial pathogens using novel molecular technologies: infection control and beyond,” Clinical Infectious Diseases, vol. 44, no. 3, pp. 418–423, 2007.
- Y.-W. Tang, A. Kilic, Q. Yang et al., “StaphPlex system for rapid and simultaneous identification of antibiotic resistance determinants and Panton-Valentine leukocidin detection of staphylococci from positive blood cultures,” Journal of Clinical Microbiology, vol. 45, no. 6, pp. 1867–1873, 2007.
- H. Stender, “PNA FISH: an intelligent stain for rapid diagnosis of infectious diseases,” Expert Review of Molecular Diagnostics, vol. 3, no. 5, pp. 649–655, 2003.
- L. E. Lehmann, K.-P. Hunfeld, T. Emrich et al., “A multiplex real-time PCR assay for rapid detection and differentiation of 25 bacterial and fungal pathogens from whole blood samples,” Medical Microbiology and Immunology, vol. 197, no. 3, pp. 313–324, 2008.
- T. P. Lodise, P. S. McKinnon, L. Swiderski, and M. J. Rybak, “Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia,” Clinical Infectious Diseases, vol. 36, no. 11, pp. 1418–1423, 2003.
- K. Chapin and M. Musgnug, “Evaluation of three rapid methods for the direct identification of Staphylococcus aureus from positive blood cultures,” Journal of Clinical Microbiology, vol. 41, no. 9, pp. 4324–4327, 2003.
- S. Shoham and M. Waga, Targeting Antimicrobial Therapy, McMahone, http://www.advandx.com/uploads/news/documents/idse__staphylococcus_aureustargeting_antimicrobial_therapy.pdf.
- U. Reischl, H.-J. Linde, M. Metz, B. Leppmeier, and N. Lehn, “Rapid identification of methicillin-resistant Staphylococcus aureus and simultaneous species confirmation using real-time fluorescence PCR,” Journal of Clinical Microbiology, vol. 38, no. 6, pp. 2429–2433, 2000.
Copyright © 2010 Edward H. Eiland III et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.