Rapid Diagnostics for Use in Antimicrobial Stewardship
October 6, 2017
Buddy Newton, MD FACP
Washington Regional Medical Center
Fayetteville, Arkansas
1. Objectives
a. Pharmacist
i. Familiarize yourself with the way MALDI works and the impact it has on rapid organism identification
ii. Understand the impact that multiplex PCR and rapid PCR identification have on infection prevention/control and antibiotic stewardship
iii. Understand the impact of procalcitonin-based algorithmic approach to antibiotic initiation, de-escalation, and discontinuation.
b. Technician
i. Define MALDI and explain how it works to rapidly identify organisms
ii. Explore how the use of multiplex PCR and rapid PCR identification can impact antibiotic prescribing
iii. Understand how using a procalcitonin-based algorithm can help with antibiotic prescribing
2. MALDI-TOF
a. Integrated System: Outcomes
3. Cepheid Xpert
4. Multiplex PCR (Film Array)
5. Challenges in Diagnosing Gastrointestinal Infections
a. Consequences of misdiagnosis and mistreatment of GI Infections
b. Gastrointestinal (GI) Panel
i. Overall 98.5% Sensitivity and 99.3% Specificity
6. Unmet Needs in Treating Sepsis
7. The FilmArray BCID Panel
a. Overall 97.5% Sensitivity and 99.8% Specificity
8. Clinical Benefits of Rapid and Accurate Diagnosis
9. Respiratory Panel (RP)
a. Overall 95% Sensitivity and 99% Specificity
10. Negative results do not always equal no infection
11. Appropriate Management of Patients with Viral Meningitis
12. Benefits of early detection of viral meningitis with enters viral PCR
13. Meningitis/Encephalitis (ME) Panel
a. Overall 94.2% Sensitivity and 99.8% Specificity
14. Procalcitonin Facts
a. Highly specific induction - produced all tissue
b. Induction and release of PCT due to bacterial infection
c. Induction and elimination of PCT
d. PCT values correlate directly with severity of bacterial load
e. Clinical Situations where PCT may be useful
f. PCT release in the absence of infection
g. Key considerations when interpreting PCT levels
h. PCT evidence-based use for various ID conditions
i. Diagnostic accuracy of PCT
j. Algorithm-based or rule-guided decisions
k. Clinical Data
15. WRMC PCT experience
a. Impact of PCT on LOS
b. PCT impact on LOT (days)
c. PCT-guided ASP Experience
d. PCT Summary