Impact of rapid blood culture identification PCR panel on optimal antibiotic use in methicillin-susceptible Staphylococcus aureus bacteremia.

UNLABELLED: Rapid identification of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia may optimize antibiotic use and clinical outcomes. The study objective was to assess the impact of the BioFire® blood culture identification (BCID) polymerase chain reaction (PCR) panel on antibiotic use and clinical outcomes in patients with MSSA bacteremia. This was a retrospective chart review of adult inpatients with MSSA bacteremia during the pre-PCR (June 2018-December 2019) and post-PCR (June 2020-December 2021) implementation periods. The primary endpoint was the difference between the pre-PCR and post-PCR groups in time to optimal MSSA antibiotic therapy (oxacillin or cefazolin). Secondary endpoints included duration of anti-MRSA antibiotic use, in-hospital mortality, hospital and ICU lengths of stay, duration of bacteremia, and 30-day MSSA-related and all-cause readmissions. Two hundred patients were included in the study (100 per group). Median time to optimal therapy was reduced by 19.9 hours in the post-PCR group (49 vs 29.1 hours, respectively, P < 0.001). PCR implementation was associated with significant reductions in the initiation of empiric anti-MRSA antibiotic therapy (98% vs 84%, P = 0.001), duration of empiric anti-MRSA antibiotic use (44.2 vs 20.9 hours, P < 0.001), and duration of bacteremia (68.6 vs 47.3 hours, P = 0.015). No significant differences in length of stay, in-hospital mortality, or 30-day MSSA-related or all-cause readmissions were observed. In patients with MSSA bacteremia, BCID PCR panel implementation decreased time to optimal MSSA antibiotic therapy, duration of bacteremia, and duration of empiric anti-MRSA antibiotic therapy.

IMPORTANCE: In this retrospective study of 200 patients with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, the implementation of the BioFire® blood culture identification polymerase chain reaction (PCR) panel was associated with a decreased time to optimal MSSA antibiotic therapy and shorter durations of empiric anti-MRSA antibiotic therapy and bacteremia. The findings demonstrate the significant role of rapid PCR testing and routine stewardship review in optimizing antimicrobial therapy and management of MSSA bacteremia.