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Can rapid negative exclusion of blood cultures by a molecular method, enzyme template generation and amplification technique (Cognitor® Minus), aid antimicrobial stewardship?

Can rapid negative exclusion of blood cultures by a molecular method, enzyme template generation and amplification technique (Cognitor® Minus), aid antimicrobial stewardship?
Can rapid negative exclusion of blood cultures by a molecular method, enzyme template generation and amplification technique (Cognitor® Minus), aid antimicrobial stewardship?

Objectives: Antimicrobial review is an important part of antimicrobial stewardship. A novel enzyme template generation and amplification technique (ETGA), the Cognitor® Minus (Momentum Bioscience, Long Hanborough, UK) test, has a 99.5% negative predictive value for bacteraemia and fungaemia. This observational study asked two questions: (1) Does a negative ETGA, indicating no bacteraemia or fungaemia, aid antimicrobial review within 48 h of admission; (2) In this real-life clinical setting, does a negative ETGA mean no bacteraemia or fungaemia?. 

Methods: Consecutive blood cultures in patients with clinical infection were tested by ETGA. Negative results indicating an absence of bacteraemia or fungaemia were reviewed by the clinical infection team. Antibiotics were reviewed in these patients, and the role of the ETGA result in antibiotic change was recorded. Patients were followed up for a week. 

Key findings: A total of 197 of 246 samples gave a negative result by ETGA. This led to a positive stewardship outcome (antimicrobials changed) in 145 (73.6%) and negative stewardship outcome (empirical antimicrobials continued) in 47 (23.9%). Of the positive stewardship outcomes, the ETGA result supported the decision not to start antimicrobials in 21 (10.7%) patients, to stop antimicrobials in 21 (10.7%), to switch from IV to oral antimicrobials in 103 (52.2%) or to discharge or leave the patient at home in 58 cases (29.4%). 

Conclusions: Enzyme template generation and amplification supports antimicrobial stewardship decisions and may have cost advantages in reducing unnecessary empirical antibiotics and antifungal agents and in discharging patients from hospital earlier. ETGA result was consistent with blood culture findings and gave an earlier negative result.

Antibiotic resistance, Antibiotic Stewardship, Rapid diagnostics
0961-7671
267-272
Dryden, Matthew
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Sitjar, Agnes
e9418799-77e1-421e-97ef-f94b357709f6
Gunning, Zoe
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Lewis, Sophie
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Healey, Richard
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Satchithananthan, Praneeth
358cbe4b-bd19-4ab1-ab1d-4ead928c7ac3
Parker, Natalie
7235b178-69b9-402b-8ced-a57b6e1f039d
Keyser, Taryn
05416b67-036f-429a-acf2-aa63093cac7c
Saeed, Kordo
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Bennett, Helen V.
84748aa1-25ae-428c-926b-3eeab4f6139a
Dryden, Matthew
a6c300f9-5c26-4884-980b-c098b0688ab1
Sitjar, Agnes
e9418799-77e1-421e-97ef-f94b357709f6
Gunning, Zoe
2dababc0-b101-423c-88fd-2ca78ce9fb9e
Lewis, Sophie
e033d675-061d-4ad4-a57a-95b4ccf4edcd
Healey, Richard
087dbf24-45fc-4ed7-a16e-d5b9f93ddf22
Satchithananthan, Praneeth
358cbe4b-bd19-4ab1-ab1d-4ead928c7ac3
Parker, Natalie
7235b178-69b9-402b-8ced-a57b6e1f039d
Keyser, Taryn
05416b67-036f-429a-acf2-aa63093cac7c
Saeed, Kordo
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Bennett, Helen V.
84748aa1-25ae-428c-926b-3eeab4f6139a

Dryden, Matthew, Sitjar, Agnes, Gunning, Zoe, Lewis, Sophie, Healey, Richard, Satchithananthan, Praneeth, Parker, Natalie, Keyser, Taryn, Saeed, Kordo and Bennett, Helen V. (2018) Can rapid negative exclusion of blood cultures by a molecular method, enzyme template generation and amplification technique (Cognitor® Minus), aid antimicrobial stewardship? International Journal of Pharmacy Practice, 26 (3), 267-272. (doi:10.1111/ijpp.12393).

Record type: Article

Abstract

Objectives: Antimicrobial review is an important part of antimicrobial stewardship. A novel enzyme template generation and amplification technique (ETGA), the Cognitor® Minus (Momentum Bioscience, Long Hanborough, UK) test, has a 99.5% negative predictive value for bacteraemia and fungaemia. This observational study asked two questions: (1) Does a negative ETGA, indicating no bacteraemia or fungaemia, aid antimicrobial review within 48 h of admission; (2) In this real-life clinical setting, does a negative ETGA mean no bacteraemia or fungaemia?. 

Methods: Consecutive blood cultures in patients with clinical infection were tested by ETGA. Negative results indicating an absence of bacteraemia or fungaemia were reviewed by the clinical infection team. Antibiotics were reviewed in these patients, and the role of the ETGA result in antibiotic change was recorded. Patients were followed up for a week. 

Key findings: A total of 197 of 246 samples gave a negative result by ETGA. This led to a positive stewardship outcome (antimicrobials changed) in 145 (73.6%) and negative stewardship outcome (empirical antimicrobials continued) in 47 (23.9%). Of the positive stewardship outcomes, the ETGA result supported the decision not to start antimicrobials in 21 (10.7%) patients, to stop antimicrobials in 21 (10.7%), to switch from IV to oral antimicrobials in 103 (52.2%) or to discharge or leave the patient at home in 58 cases (29.4%). 

Conclusions: Enzyme template generation and amplification supports antimicrobial stewardship decisions and may have cost advantages in reducing unnecessary empirical antibiotics and antifungal agents and in discharging patients from hospital earlier. ETGA result was consistent with blood culture findings and gave an earlier negative result.

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Dryden et al 2018 International Journal of Pharmacy Practice - Version of Record
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More information

Accepted/In Press date: 4 July 2017
e-pub ahead of print date: 18 August 2017
Published date: June 2018
Keywords: Antibiotic resistance, Antibiotic Stewardship, Rapid diagnostics

Identifiers

Local EPrints ID: 420862
URI: http://eprints.soton.ac.uk/id/eprint/420862
ISSN: 0961-7671
PURE UUID: 7e7c2cb7-3b69-4036-91af-2bc47d46cd9a
ORCID for Kordo Saeed: ORCID iD orcid.org/0000-0003-0123-0302

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Date deposited: 17 May 2018 16:30
Last modified: 07 Oct 2020 02:25

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Contributors

Author: Matthew Dryden
Author: Agnes Sitjar
Author: Zoe Gunning
Author: Sophie Lewis
Author: Richard Healey
Author: Praneeth Satchithananthan
Author: Natalie Parker
Author: Taryn Keyser
Author: Kordo Saeed ORCID iD
Author: Helen V. Bennett

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