A prospective study evaluating the effect of a ‘Diagnostic Stewardship Care-Bundle’ for automated blood culture diagnostics
ABSTRACT: Objectives: We prospectively implemented a diagnostic stewardship care-bundle checklist, ‘Sepsis-48 DSB’, with the aim of reducing intervening duration of key steps of automated blood culture diagnostics (aBCD). Methods: Sepsis-48 DSB was implemented for automated blood culture bottles (B...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | Journal of Global Antimicrobial Resistance |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213716523001066 |
| _version_ | 1797689503321686016 |
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| author | Ayush Gupta Farha Siddiqui Bhoomika Saxena Shashank Purwar Saurabh Saigal Jai Prakash Sharma Sanjeev Kumar |
| author_facet | Ayush Gupta Farha Siddiqui Bhoomika Saxena Shashank Purwar Saurabh Saigal Jai Prakash Sharma Sanjeev Kumar |
| author_sort | Ayush Gupta |
| collection | DOAJ |
| description | ABSTRACT: Objectives: We prospectively implemented a diagnostic stewardship care-bundle checklist, ‘Sepsis-48 DSB’, with the aim of reducing intervening duration of key steps of automated blood culture diagnostics (aBCD). Methods: Sepsis-48 DSB was implemented for automated blood culture bottles (BCBs) received from adult intensive care units (AICUs) during the intervention period (P2; July 2020–June 2021) and intervening durations were compared with those during the retrospective, pre-intervention period (P1; March–June 2020). During both periods, provisional blood culture reports (pBCR) were issued wherein direct microbial identification (dID) was performed in BCBs with Gram-negatives by directly inoculating conventional biochemical tests and direct antimicrobial susceptibility testing (dAST) using EUCAST RAST method. The results were compared with the standard of care (SoC) method (i.e. full incubation followed by identification and AST by VITEKⓇ-2 Compact). Results: During P2, significant reductions in loading time (LT) [median: 63.5 vs. 32 minutes, P < 0.001], time to dID+dAST performance (TTD) [186 vs. 115 minutes, P = 0.0018] and an increase in compliance to bundle targets [LT ≤45: 44% vs. 66%, P = 0.006 and TTD ≤120: 34% vs. 51.7%, P = 0.03] were observed. Using dID+dAST method, results were read 694 minutes earlier than SoC method. Of 176 pBCR, 165 (94%) were concordant with SoC in microbial identification of species. Categorical agreement for any drug-bug combination was 92.7% (1079/1164) and corresponding major, very major, and minor error rates were 8.8% (19/216), 4.9% (45/921), and 1.8% (21/1164), respectively. Conclusion: The ‘diagnostic stewardship care-bundle’ strategy was successfully implemented with considerable diagnostic accuracy leading to significant reductions in duration of targeted steps of aBCD. |
| first_indexed | 2024-03-12T01:46:29Z |
| format | Article |
| id | doaj.art-7763f72b7dea4619b26e6725aef3e105 |
| institution | Directory Open Access Journal |
| issn | 2213-7165 |
| language | English |
| last_indexed | 2024-03-12T01:46:29Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Global Antimicrobial Resistance |
| spelling | doaj.art-7763f72b7dea4619b26e6725aef3e1052023-09-09T04:55:13ZengElsevierJournal of Global Antimicrobial Resistance2213-71652023-09-0134119126A prospective study evaluating the effect of a ‘Diagnostic Stewardship Care-Bundle’ for automated blood culture diagnosticsAyush Gupta0Farha Siddiqui1Bhoomika Saxena2Shashank Purwar3Saurabh Saigal4Jai Prakash Sharma5Sanjeev Kumar6Department of Microbiology, All India Institute of Medical Science (AIIMS), Bhopal, India; Corresponding author. Mailing address: Department of Microbiology, Ground Floor, College Building, AIIMS Bhopal, Saket Nagar, Bhopal, Madhya Pradesh 462020.Department of Microbiology, All India Institute of Medical Science (AIIMS), Bhopal, IndiaDepartment of Microbiology, All India Institute of Medical Science (AIIMS), Bhopal, IndiaDepartment of Microbiology, All India Institute of Medical Science (AIIMS), Bhopal, IndiaDepartment of Critical Care and Anesthesiology, All India Institute of Medical Science, (AIIMS), Bhopal, IndiaDepartment of Critical Care and Anesthesiology, All India Institute of Medical Science, (AIIMS), Bhopal, IndiaDepartment of Community and Family Medicine, All India Institute of Medical Science, (AIIMS), Bhopal, IndiaABSTRACT: Objectives: We prospectively implemented a diagnostic stewardship care-bundle checklist, ‘Sepsis-48 DSB’, with the aim of reducing intervening duration of key steps of automated blood culture diagnostics (aBCD). Methods: Sepsis-48 DSB was implemented for automated blood culture bottles (BCBs) received from adult intensive care units (AICUs) during the intervention period (P2; July 2020–June 2021) and intervening durations were compared with those during the retrospective, pre-intervention period (P1; March–June 2020). During both periods, provisional blood culture reports (pBCR) were issued wherein direct microbial identification (dID) was performed in BCBs with Gram-negatives by directly inoculating conventional biochemical tests and direct antimicrobial susceptibility testing (dAST) using EUCAST RAST method. The results were compared with the standard of care (SoC) method (i.e. full incubation followed by identification and AST by VITEKⓇ-2 Compact). Results: During P2, significant reductions in loading time (LT) [median: 63.5 vs. 32 minutes, P < 0.001], time to dID+dAST performance (TTD) [186 vs. 115 minutes, P = 0.0018] and an increase in compliance to bundle targets [LT ≤45: 44% vs. 66%, P = 0.006 and TTD ≤120: 34% vs. 51.7%, P = 0.03] were observed. Using dID+dAST method, results were read 694 minutes earlier than SoC method. Of 176 pBCR, 165 (94%) were concordant with SoC in microbial identification of species. Categorical agreement for any drug-bug combination was 92.7% (1079/1164) and corresponding major, very major, and minor error rates were 8.8% (19/216), 4.9% (45/921), and 1.8% (21/1164), respectively. Conclusion: The ‘diagnostic stewardship care-bundle’ strategy was successfully implemented with considerable diagnostic accuracy leading to significant reductions in duration of targeted steps of aBCD.http://www.sciencedirect.com/science/article/pii/S2213716523001066Diagnostic stewardshipGram-negative bacteraemiaCare-bundleRapid antimicrobial susceptibility testing (RAST)EUCAST |
| spellingShingle | Ayush Gupta Farha Siddiqui Bhoomika Saxena Shashank Purwar Saurabh Saigal Jai Prakash Sharma Sanjeev Kumar A prospective study evaluating the effect of a ‘Diagnostic Stewardship Care-Bundle’ for automated blood culture diagnostics Journal of Global Antimicrobial Resistance Diagnostic stewardship Gram-negative bacteraemia Care-bundle Rapid antimicrobial susceptibility testing (RAST) EUCAST |
| title | A prospective study evaluating the effect of a ‘Diagnostic Stewardship Care-Bundle’ for automated blood culture diagnostics |
| title_full | A prospective study evaluating the effect of a ‘Diagnostic Stewardship Care-Bundle’ for automated blood culture diagnostics |
| title_fullStr | A prospective study evaluating the effect of a ‘Diagnostic Stewardship Care-Bundle’ for automated blood culture diagnostics |
| title_full_unstemmed | A prospective study evaluating the effect of a ‘Diagnostic Stewardship Care-Bundle’ for automated blood culture diagnostics |
| title_short | A prospective study evaluating the effect of a ‘Diagnostic Stewardship Care-Bundle’ for automated blood culture diagnostics |
| title_sort | prospective study evaluating the effect of a diagnostic stewardship care bundle for automated blood culture diagnostics |
| topic | Diagnostic stewardship Gram-negative bacteraemia Care-bundle Rapid antimicrobial susceptibility testing (RAST) EUCAST |
| url | http://www.sciencedirect.com/science/article/pii/S2213716523001066 |
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