Rapid Diagnosis, Right Antibiotics, Right Time

February 2016

With so many pathogens, it often takes time to identify the culprit – sometimes up to 72 hours. While some pathogens might leave a calling card, such as a distinctive rash, most have ambiguous signs and symptoms. 

At Children’s Hospital Colorado, the clinical microbiology team has adopted new technology that allows identification of the pathogen in just 1–2 hours. (Pictured above, left to right: Stacey Hamilton, MT (ASCP) SM, Manager of Mircrobiology; Amanda Hurst, PharmD, Antimicrobial Steward; Sarah Parker, MD, Medical Director of Antimicrobial Stewardship; Sam Dominguez, MD, PhD, Medical Director of Microbiology; Christine Robinson, PhD, Scientific Director of Microbiology; and Kevin Messacar, MD, Pediatric Hospitalist and Infectious Disease Researcher)

Children’s Colorado has been using the FilmArray​ for respiratory infections since 2012, blood infections since January 2015 and gastrointestinal infections since October 2015.

The FilmArray machine simultaneously tests for multiple bacterial, viral, fungal and protozoan pathogens. Just 1–2 hours later, the system generates a report indicating the cause of the infection.

Kevin Messacar​, MD, pediatric infectious disease physician, has been tracking and evaluating this technology over the past year.

“There are major benefits in the rapid identification of infectious diseases,” he said. “Previously a patient would be given powerful, broad-spectrum antibiotics while we run one test after another, trying to identify the cause of their illness. Since January 2015 we’ve managed to achieve optimal antimicrobial therapy for blood infections in just 26 hours, down from 60.”

One group of clinicians at Children’s Colorado is particularly pleased with the new process. Sarah Parker​, MD, medical director of the Antimicrobial Stewardship Team, is responsible for monitoring antibiotic use across the hospital.

“Our team receives the results from the FilmArray and communicates them to the provider,” Dr. Parker explained. “We are able to recommend appropriate clinical action, specific to the patient, which makes sure we direct the right antimicrobial to the right patient, at the right time.”

Dr. Messacar explains that this represents something of a paradigm shift.

“This means we can now offer physicians real-time support for infectious disease cases. The team is playing a role similar to that of a radiologist interpreting imaging and providing radiologic expertise; we provide not only the result of the test but our expertise as well.  This revolutionizes the way we treat these patients, and we hope the model we establish will be applicable to other children’s hospitals across the country.”

This new process offers several benefits in addition to reducing antibiotic use. “With rapid test results comes rapid clinical action,” Dr. Messacar said. “Patients receive the right treatment sooner, costs decrease and length of stay is reduced – with some patients not requiring admission at all.”

Sam Dominguez​, MD, PhD, medical director of the microbiology lab at Children’s Colorado, emphasized that such a change requires careful management. 

“The FilmArray is very sensitive,” he said. “It is capable of picking up a pathogen in a patient’s intestines, for example, that is not actually causing disease. It is important that we interpret and communicate our results thoughtfully and proactively.”

With new technology released all the time, the team at Children’s Colorado is constantly trying to stay ahead of the game. “The FDA recently cleared the FilmArray cerebrospinal fluid panel for use, so we will incorporate that in the near future,” Dr. Parker said. “Our next step is then to introduce a MALDI-TOF​ mass spectrometer, which allows us to identify microbes at a much more precise level. This means we will be able to identify bacteria that few physicians have heard of.”

For Dr. Messacar, this technology is an exciting way to bridge research and clinical practice, but he notes it is important to make sure the research is practical.

“We need stewards for our clinical technology,” he said. “Some tests are very expensive but don’t offer anything in terms of clinical outcomes. New technology should conserve and not consume resources, so we’re trying to be very careful to make sure that we don’t add to health care costs but instead create more effective clinical care.”

Then vs Now: Identifying a Central Nervous System Infection

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