Clinical and economical improvements after introducing rapid identification of bacteria and early antibiotic susceptibility testing in sepsis and bloodstream infections.
The PHENO Medical EcoNOmic EvaluatioN – PHENOMENON study was conducted in a tertiary care hospital in Germany.
The study is a historically controlled interventional study comparing the time to result and the economic impact of the new fast ID/AST test with the results achieved by standard-of-care (SoC) in patients with sepsis or bloodstream infection that had BC+ and were admitted to the ICU. The basic assumption was that the new test can provide results faster, enable earlier therapy adjustment and therefore is economically favourable. In the hospital where the study was conducted, every BC drawn was processed in the 24/7 lab until positivity. Positive BC (BC+) are sent to the microbiology lab, which is approximately 80 km away and does not operate 24/7. In this lab, an ID by MALDI-TOF is processed and AST is obtained with the VITEK®2. Once the complete AST is ready, it is transferred via electronic data connection into the hospital information system (HIS). In the prospective cohort, positive BC were processed with the PhenoTM system in the 24/7 onsite lab and then sent on to the microbiology lab for comparison purposes and to maintain the current SoC. The PhenoTM test uses 5 ml of blood from each bottle and hands on-time of the system is 2 minutes [14]. In both groups, the antimicrobial therapy (AT) was reviewed by two experienced stewardship experts and separately by an independent reviewer.
The new test delivers ID in 60–90 minutes, AST after 7 hours.
WE IMPROVED MORTALITY AND GENERATED SAVINGS!
Clinical and economical improvements after introducing rapid identification of bacteria and early antibiotic susceptibility testing in sepsis and bloodstream infections.
Conclusion
The new PhenoTM ID+AST test leads to faster and clinically meaningful results and saves money by shortening LOS on the ICU.
Results: 223 historical and 200 prospective patients were included. Time to result (ITT) was shortened by 51.1 hours (83 vs. 31.9; p<0.001). Overall savings (mITT) were 257,100 € (–301,264 € vs. –44,164 €). 143 of 181 (79%) patients had a test performed, 126 of 143 (88%) having a clinically useable result. 40 (32%) had IAT vs. 65 (29%) in the historic cohort. Median time to AST in PP was shortened by 61.7 hours (89.5 vs. 27.8; p<0.001). LOS was shortened 7 days (28 vs. 19; p=0.226) and mortality was 8% (40.5% vs. 32.5%; p=0.440) lower. Median CM +3,074.80 € per case (–2,350.50 € vs. +724.70 €; p=0.040).
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