Clinical Outcomes with Implementation of Accelerate Pheno™ Blood Culture Detection System for Gram-Negative Bacteremia
Shu Xian Lee,
Benita Yong Wu,
Kurt Suter,
Matthew Scott Lokant,
Andrew Ward,
Amy Spigelmyer,
Jesse Martin Thompson,
Ryan Demkowicz,
Catessa Howard,
Paul Rocco LaSala,
Rebecca Reece
Issue:
Volume 8, Issue 3, May 2023
Pages:
27-34
Received:
30 June 2023
Accepted:
25 July 2023
Published:
4 August 2023
Abstract: Delayed treatment in bacteremia increases patient morbidity and healthcare costs. Accelerate Pheno™ Blood Culture Detection System (AXDX) is a novel diagnostic technology for the rapid detection of gram-negative bacteremia. Studies have shown accurate and faster time to speciation and sensitivity (TTSS) by AXDX compared to conventional modality. However, however, our study further examined the direct impact of AXDX on clinical outcomes and cost. Our retrospective study consisted of 178 patients at least 18 years old admitted to our academic medical institution with gram-negative bacteremia. The pre-AXDX group had 91 patients admitted in 2019 while the post-AXDX group had 87 patients admitted in 2021. Demographics, microbes, TTSS, time to de-escalation of therapy (TTDeT), length of stay (LOS), readmissions, and Clostridioides difficile infection (CDI) rates were recorded and differences between the cohorts were statistically analyzed. The pre-AXDX group had 51.32% females, mean age of 60.28 years, mean Charlson Co-morbidity Index (CCMI) of 2.23, mean LOS of 21.19 days, and mean Pitt-Bacteremia Score (PBS) of 2.35. The post-AXDX group had 51.92% females, mean age of 63.66 years, mean CCMI of 2.99, median LOS of 15.02 days, and mean PBS of 2.71. Both groups’ top two sources of bacteremia were urinary and gastrointestinal and the two most common microbes were Escherichia coli and Klebsiella pneumoniae. Pre-AXDX's mean TTSS was 70.95 hours and 62.92 hours for post-AXDX. Pre-AXDX's mean TTDeT was 73.90 hours and 43.85 hours for post-AXDX. The pre-AXDX cohort had 7.12% increase in related readmissions, 5.45% more CDI, and 0.26% increase in inpatient mortality. In addition to faster TTSS with AXDX as seen with previous studies, our study shows clinical advantages with AXDX use. While both groups were comparable in bacteremia sources and microbes. The post-AXDX group had higher CCMI and PBS scores, indicating they were more ill. Despite this, the pre-AXDX group had longer TTDeT by 30.05 hours, longer mean LOS by 6.17 days, 5.45% more CDI, 7.12% more readmissions, and 0.26% more mortality rates. The pre-AXDX group also reported adverse reactions to antibiotics while the post-AXDX had none. Our data shows AXDX use improves clinical outcomes with fewer adverse effects, mortality, and CDI rates and decreases cost with shorter LOS and lower readmission rates.
Abstract: Delayed treatment in bacteremia increases patient morbidity and healthcare costs. Accelerate Pheno™ Blood Culture Detection System (AXDX) is a novel diagnostic technology for the rapid detection of gram-negative bacteremia. Studies have shown accurate and faster time to speciation and sensitivity (TTSS) by AXDX compared to conventional modality. Ho...
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Evaluation of the Medical Laboratory Equipment Standardization and Harmonization Program on Availability of Reagents and Controls at Council Hospitals
Issue:
Volume 8, Issue 3, May 2023
Pages:
35-50
Received:
30 June 2023
Accepted:
2 August 2023
Published:
28 August 2023
Abstract: This study evaluated the effectiveness of the Medical Laboratory Equipment Standardization and Harmonization Program on the availability of reagents and controls at council hospitals in Arusha, Tanzania. Specifically, the study assessed the stakeholders’ participation in the program based on their knowledge and accessibility of the program guidelines, the availability of standardized laboratory equipment at the council hospital laboratories also assessed changes in the availability of the reagents and controls for the standardized equipment at the council hospitals’ laboratories. Purposive sampling and Simple random sampling were used to obtain the sample size for the study. The study randomly sampled 64 respondents from district hospitals where 5 District Medical Officers, 19 Laboratory Assistants, 3 Laboratory Scientists, 2 Medical Officer In charge, and 28 Laboratory Technologists were enrolled, also staff from the council health management team (CHMT) whereas 7 District Laboratory Technologist were also enrolled in the study. Quantitative data were collected using Questionnaire tools. Analysis of data was done using SPSS software to obtain descriptive information between different variables. Study findings revealed that there was inadequate knowledge among key stakeholders implementing the program as 51.5% Low; 43.75% moderate; and 4.6% High levels of knowledge. Stakeholder’s accessibility to the program Guideline was 15.60%, Council Hospital Accessibility to Standardized Laboratory Equipment was 90.60%, Accessibility and Affordability of Laboratory Reagents and Controls was 79.70%, and thus an overall increase in the availability of Laboratory Reagents and Controls at the Council Hospitals was 65.60%. The study further revealed that the standardization program had a positive impact on the availability of reagents and control at Council hospitals as participants revealed an increase in the availability of reagents in their laboratories, but for more improvement of the program, it recommended that dissemination of the Standardization Guideline to all key stakeholders as well as engaging them in the implementation so as to improve ownership and efficiency of the program. The study also recommends to the government to make policies and regulations that are in line with the standardized program as well as ensure standardization program reaches all health facilities, including private and faith-based organizations with the aim of improving overall laboratory services across the country.
Abstract: This study evaluated the effectiveness of the Medical Laboratory Equipment Standardization and Harmonization Program on the availability of reagents and controls at council hospitals in Arusha, Tanzania. Specifically, the study assessed the stakeholders’ participation in the program based on their knowledge and accessibility of the program guidelin...
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