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BRIEF RESEARCH REPORT article

Front. Cell. Infect. Microbiol.
Sec. Clinical Infectious Diseases
Volume 14 - 2024 | doi: 10.3389/fcimb.2024.1513408

Rapid diagnostic testing combined with immediate infectious diseases consultation increases the rate of septic intensive care unit patients on targeted antibiotic therapy

Provisionally accepted
Evelyn Kramme Evelyn Kramme 1*Nadja Käding Nadja Käding 2,3Tobias Graf Tobias Graf 4Karolin Schmoll Karolin Schmoll 4Heidi Linnen Heidi Linnen 5Katharina Barbara Nagel Katharina Barbara Nagel 2Esther Grothe-Levi Esther Grothe-Levi 2Susanne Hauswaldt Susanne Hauswaldt 2Dennis Nurjadi Dennis Nurjadi 2,3Jan Rupp Jan Rupp 2,6
  • 1 German Center for Infection Research, Hamburg-Lübeck-Borstel-Riems site, Lübeck, Germany, Department of Infectious Diseases, UKSH Campus Luebeck, Luebeck, Germany
  • 2 Institute of Medical Micobiology, University of Luebeck and University Hospital Schleswig-Holstein, Luebeck, Germany
  • 3 German Center for Infection Research, Hamburg-Luebeck-Borstel-Riems site, Luebeck, Germany
  • 4 University Heart Center Lübeck and German Center for Cardiovascular Research, University Hospital Schleswig-Holstein, Campus Lübeck, , Germany, 23538 Lübeck, Germany
  • 5 Department of Anaesthesiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck,, Luebeck, Germany
  • 6 German Center for Infection Research, Hamburg-Lübeck-Borstel-Riems site,, Department of Infectious Diseases, UKSH Campus Luebeck, Luebeck, Germany

The final, formatted version of the article will be published soon.

    Objectives: To evaluate the impact of rapid diagnostic testing (RDT) combined with immediate infectious diseases (ID) consultation on the treatment of septic patients with positive blood cultures on intensive care units in a setting without 24/7 service.Adult ICU patients of a tertiary care hospital with positive blood cultures were included from January 2019 to December 2020. The control group underwent routine laboratory diagnostic, for the intervention group RDT was applied with immediate ID consultation.In 77 out of 91 patients of the intervention group the pathogen was identified by RDT. Regarding antimicrobial susceptibility testing (AST), genotypic testing (ePlex®) was successful for Gram-positive cocci, but inadequate for Gram-negative rods. Phenotypic resistance testing with the Accelerate PhenoTest® took too long to be successfully integrated in the intervention.Adaptation of empirical antibiotic therapy was recommended for 72.7% of the patients. Adherence to the ID consultation post RDT results was high with 82.3%. In the control group, adaptation of the initial antibiotic therapy would have been recommended for 81.8% patients, if the species identification would have been available. Overall adherence to local antibiotic therapy guideline for sepsis was significantly lower in the control than in the intervention group (27.8% versus 89.3%, p<0.001).Integration of a RDT system in the microbiological workflow for septic patients on ICU combined with standardized ID intervention led to a significantly higher percentage of adequate antimicrobial treatment and greater adherence to local antibiotic therapy recommendations, even in a setting where 24/7 service is not available.

    Keywords: Sepsis, Rapid diagnostic testing, infectious diseases consultation, Adequate antibiotic therapy, Blood Stream infection (BSI), Antimicrobial stewardship (AMS)

    Received: 18 Oct 2024; Accepted: 20 Dec 2024.

    Copyright: © 2024 Kramme, Käding, Graf, Schmoll, Linnen, Nagel, Grothe-Levi, Hauswaldt, Nurjadi and Rupp. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Evelyn Kramme, German Center for Infection Research, Hamburg-Lübeck-Borstel-Riems site, Lübeck, Germany, Department of Infectious Diseases, UKSH Campus Luebeck, Luebeck, Germany

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.