Abstract
Background
Bacteremia causes a major worldwide burden, in terms of financial and productivity
costs, as well the morbidity and mortality it can ultimately cause. Proper treatment
of bacteremia is a challenge because of the species-dependent response to antibiotics.
The T2Bacteria Panel is a U.S. Food and Drug Administration–cleared and culture-independent
assay for detection of bacteremia, including common ESKAPE pathogens—Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa—and provides species identification in as little as 3.6 h directly from blood.
Objective
Our aim was to evaluate the T2Bacteria assay performance and potential to affect patient
care in the emergency department (ED).
Methods
ED patients from a Louisiana and Florida center were enrolled as part of the T2Bacteria
Panel clinical study, which was prospective and noninterventional. Blood samples for
blood culture (BC) and T2Bacteria were matched in time and anatomic location.
Results
Data from 137 ED patients were evaluated. Relative to BC, T2Bacteria showed 100% positive
percent agreement and 98.4% negative percent agreement. In addition, for species on
the T2Bacteria Panel, the T2Bacteria assay detected 25% more positives associated
with infection, and on average identified the infectious species 56.6 h faster. The
T2Bacteria assay covered 70.5% of all species detected by BC. Finally, relative to
actual care, the T2Bacteria assay could have potentially focused therapy in 8 patients,
reduced time to a species-directed therapy in 4 patients, and reduced time to effective
therapy in 4 patients.
Conclusions
In this ED population, the T2Bacteria assay was a rapid and sensitive detector of
bacteremia from common ESKAPE pathogens and showed the theoretical potential to influence
subsequent patient therapy, ranging from antibiotic de-escalation to faster time to
effective therapy.
Keywords
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References
- Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock.Crit Care Med. 2006; 34: 1589-1596
- Integrating rapid pathogen identification and antimicrobial stewardship significantly decreases hospital costs.Arch Pathol Lab Med. 2013; 137: 1247-1254
- Impact of rapid organism identification via matrix-assisted laser desorption/ionization time-of-flight combined with antimicrobial stewardship team intervention in adult patients with bacteremia and candidemia.Clin Infect Dis. 2013; 57: 1237-1245
- Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia.J Infect. 2014; 69: 216-225
- Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis.Antimicrob Agents Chemother. 2010; 54: 4851-4863
- Blood culture turnaround time in US acute care hospitals and implications for laboratory process optimization.J Clin Microbiol. 2018; 56
- Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).JAMA. 2016; 315: 762-774
- Time to Treatment and mortality during mandated emergency care for sepsis.N Engl J Med. 2017; 376: 2235-2244
- National action plan for combating antibiotic-resistant bacteria. The White House, Washington, DC2015
- T2 magnetic resonance for the diagnosis of bloodstream infections: charting a path forward.J Antimicrob Chemother. 2018; 73: iv2-iv5
- Microbial diagnosis of bloodstream infection: towards molecular diagnosis directly from blood.Clin Microbiol Infect. 2015; 21: 323-331
- Rapid diagnosis of bacteremia.Appl Microbiol. 1969; 18: 458-463
- Implementation of rapid diagnostics with antimicrobial stewardship.Expert Rev Anti Infect Ther. 2016; 14: 1065-1075
- Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America.Clin Infect Dis. 2009; 48: 1-12
- Performance of the T2Bacteria Panel for diagnosing bloodstream infections. A Diagnostic accuracy study.Ann Intern Med. 2019; 170: 845-852
- Probable inference, the law of succession, and statistical inference.J Am Stat Assoc. 1927; 22: 209-212
- Statsmodels: Econometric and Statistical Modeling with Python.in: Proceedings of the 9th Python in Science Conference. 57. 2010: 61
- SciPy.Open Source Scientific Tools for Python, 2001scipy.orgDate accessed: February 17, 2019
- Detecting Infections Rapidly and Easily for Candidemia Trial, Part 2 (DIRECT2): a prospective, multicenter study of the T2Candida Panel.Clin Infect Dis. 2018; 66: 1678-1686
- In vitro evaluation of BacT/Alert FA blood culture bottles and T2Candida assay for detection of Candida in the presence of antifungals.J Clin Microbiol. 2018; 56
- Updated review of blood culture contamination.Clin Microbiol Rev. 2006; 19: 788-802
- The IRIDICA BAC BSI assay: rapid, sensitive and culture-independent identification of bacteria and candida in blood.PLoS One. 2016; 11: e0158186
- Demise of polymerase chain reaction/electrospray ionization-mass spectrometry as an infectious diseases diagnostic tool.Clin Infect Dis. 2018; 66: 452-455
- Systematic review and meta-analysis of clinical and economic outcomes from the implementation of hospital-based antimicrobial stewardship programs.Antimicrob Agents Chemother. 2016; 60: 4840-4852
- Adaptation of cost analysis studies in practice guidelines.Medicine (Baltimore). 2015; 94: e2365
- Is de-escalation of antimicrobials effective? A systematic review and meta-analysis.Int J Infect Dis. 2016; 49: 71-79
- Editorial commentary: rapid blood culture identification: the value of a randomized trial.Clin Infect Dis. 2015; 61: 1081-1083
- Better tests, better care: improved diagnostics for infectious diseases.Clin Infect Dis. 2013; 57: S139-S170
Article info
Publication history
Published online: January 23, 2020
Accepted:
November 23,
2019
Received in revised form:
October 1,
2019
Received:
April 10,
2019
Footnotes
Conflicts of Interest—Joseph E. Marturano and Thomas J. Lowery are employed and have stock ownership in T2 Biosystems. The remaining authors disclose no conflicts.
Data were presented at the 37th Annual Emergencies in Medicine Conference, Park City, UT, February 2019 and at the 29th Annual European Congress of Clinical Microbiology and Infectious Diseases, Amsterdam, Netherlands, April 2019.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
