ABSTRACT
IMPORTANCE: Testing for enteric bacterial pathogens in patients hospitalized for more than 3 days is almost always inappropriate. Our study validates the utility of the 3-day rule and the use of clinical decision support tools to decrease unnecessary testing of enteropathogenic bacteria other than C. difficile. Overriding the restriction was very low yield. Our study highlights the importance of diagnostic stewardship and further refines the criteria for allowing providers to override the restriction while monitoring the impact of the interventions.
Subject(s)
Clostridioides difficile , Humans , Diarrhea/microbiology , EnterobacteriaceaeABSTRACT
Peptide nucleic acid fluorescence in situ hybridization (PNA FISH) is a rapid diagnostic assay that can identify certain organisms growing in blood cultures 30-90 min from the time of positive Gram-stain. Existing studies have demonstrated a clinical utility with this assay when antibiotic stewardship programs assist clinicians with interpreting the results. However, the benefit of these rapid assays in the absence of concomitant antibiotic stewardship involvement is unclear. In this randomized study of 220 patients with enterococcal or streptococcal bacteremia, we found that PNA FISH, in the absence of concomitant input from an antibiotic stewardship program, had no impact on time to effective or optimal therapy, length of hospital stay, or in-hospital mortality. Our results suggest that in the absence of guidance from an antibiotic stewardship program, the clinical benefits of rapid diagnostic microbiological tools may be reduced.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteremia/diagnosis , Drug Utilization/standards , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Cocci/isolation & purification , In Situ Hybridization, Fluorescence/methods , Molecular Diagnostic Techniques/methods , Aged , Bacteremia/microbiology , Bacteremia/mortality , Bacteremia/pathology , Blood Culture , Female , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/mortality , Gram-Positive Bacterial Infections/pathology , Gram-Positive Cocci/classification , Gram-Positive Cocci/drug effects , Humans , Length of Stay , Male , Middle Aged , Peptide Nucleic Acids , Random Allocation , Survival Analysis , Time Factors , Treatment OutcomeABSTRACT
We analyzed 1,598 Candida glabrata isolates for the presence of the cryptic species Candida nivariensis and Candida bracarensis. Both species were very rare in this collection (0.2% prevalence), despite the number of isolates analyzed and the global distribution of the isolates. We saw no associated antifungal resistance in C. nivariensis.
Subject(s)
Candida/classification , Candida/genetics , Candidiasis/microbiology , Candida/isolation & purification , Candidiasis/epidemiology , DNA, Fungal/genetics , Drug Resistance, Fungal , Humans , Microbial Sensitivity Tests , Polymerase Chain Reaction/methods , PrevalenceABSTRACT
Candida albicans and Candida glabrata can be identified in blood culture bottles within 2.5 h using peptide nucleic acid fluorescence in situ hybridization. A 1.25-h protocol was compared to the standard with 40 positive (clinical and spiked) blood culture bottles tested in batches of 5. All C. albicans (15) and C. glabrata (16) isolates, alone or mixed, were identified correctly using both protocols, whereas 18 isolates (five other species) were negative by both protocols. This shortened method will significantly reduce the time to identification.
Subject(s)
Blood/microbiology , Candida albicans/isolation & purification , Candida glabrata/isolation & purification , In Situ Hybridization, Fluorescence/methods , Mycology/methods , Peptide Nucleic Acids , Humans , Sensitivity and Specificity , Time FactorsABSTRACT
We evaluated the performance of the Candida albicans/Candida glabrata peptide nucleic acid fluorescent in situ hybridization (PNA FISH) method, a rapid two-color assay for detection of C. albicans and C. glabrata, in a multicenter study. The assay is designed for use directly from positive blood culture bottles in a FISH format. Intact, fixed cells are labeled fluorescent green (C. albicans) or fluorescent red (C. glabrata) by rRNA hybridization of fluorophore-labeled PNA probes. Results are available <3 h after cultures signal positive. An evaluation of 197 routine blood culture bottles newly positive for yeast by Gram staining was performed at five hospitals. The sensitivities of detection for C. albicans, and C. glabrata were 98.7% (78/79) and 100% (37/37), respectively, and the specificity for both components of the assay was 100% (82/82). The assay was also evaluated with 70 fungal reference strains and was challenged in the BacT/ALERT microbiological detection system with spiked blood culture bottles. These results support the use of the assay for rapid, simultaneous identification of C. albicans and C. glabrata in positive blood culture bottles. This rapid assay may aid in the selection of initial antifungal drugs, leading to improved patient outcomes.
