Background: Blood cultures are a common investigation for children admitted to hospital. In routine practice, it takes at least 24 hours to identify an organism as a contaminant or clinically significant. FilmArray Blood Culture Identification Panel (FA-BCIP) is a multiplex polymerase chain reaction that can detect 24 pathogens within 1 hour. We assessed whether results from FA-BCIP lead to changes in clinical management in a tertiary referral paediatric hospital.
Methods: We prospectively studied children having blood cultures taken at our tertiary children’s hospital. Blood cultures were monitored and organisms identified using standard methods. FA-BCIP was performed when growth was initially detected in first positive blood cultures per episode, between January 1 and June 30, 2014. Assessment of whether the FA-BCIP result altered clinical management was made, specifically focused on antimicrobial stewardship and length of stay.
Results: FA-BCIP was done on 117 positive blood cultures; 74 (63%) grew clinically significant organisms, 43 (37%) grew contaminants. FA-BCIP results were judged to alter clinical management in 63 of the 117 episodes (54%). Antimicrobials were started/altered in 23 (19%) episodes and de-escalated/withheld/stopped in 29 (25%) episodes. Ten children were discharged from hospital earlier, which saved a cumulative total of 14 bed days.
Conclusions: Rapid identification of microorganisms in pediatric blood cultures by FA-BCIP, led to changes in clinical management for half of the episodes. This improved antimicrobial stewardship and allowed early discharge from hospital for 10% of children. Future studies should focus on how best to use this technology in a cost-effective manner.
From the *Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom; †Department of Paediatric Infectious Diseases and Immunology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom; ‡Department of Microbiology, Rotunda Hospital, Dublin, Ireland; §Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland; ¶Department of Microbiology, and ‖Department of Oncology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom.
Accepted for publication January 11, 2016.
Presented in part at the European Paediatric Infectious Diseases Society Meeting, Leipzig; May 15, 2015.
The authors have no funding or conflicts of interest to disclose.
Address for correspondence: Stephen Ray, MPhil, Institute of Infection and Global Health, University of Liverpool, 8 West Derby Street, Liverpool L69 7BE, United Kingdom. E-mail: firstname.lastname@example.org