Staphylococcal Bacteremia

Infection vs. Contamination

Rapid identification of S. aureus and Coagulase-Negative Staph to help ensure appropriate and effective therapy for patients with true staphylococcal bacteremia


“Combining a rapid diagnostic test (PNA FISH) with prompt and direct communication of microbiological results is associated with improved outcomes.”

Ly et al. Therapeutics and Clinical Risk Management. 2008 June; 4(3):637-40.
 

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The Challenge

Early, Appropriate and Effective Therapy for Patients with S. aureus and CNS Bacteremia

Staphylococci are the most frequent causes of bloodstream infections and blood culture contamination. True infections with Staphylococcus aureus present considerable clinical challenges and increase mortality rates, prolong hospital stays and add significant extra costs. The lack of timely identification of Methicillin-resistant S. aureus (MRSA) contributes to this clinical challenge, forcing clinicians to treat empirically which can be costly, ineffective and contribute to increasing antibiotic resistance.

Blood culture contamination with Coagulase-Negative Staph (CNS) on the other hand leads to unnecessary coverage with broad-spectrum antibiotic therapy, extra length of stay and unnecessary extra costs.

The challenge for clinical is how to ensure early, appropriate therapy for patients with true S. aureus bacteremia while avoiding unnecessary therapy for patients with contaminated blood cultures.
 
 
 

The Dilemma

Conventional Identification of S. aureus vs. CNS Takes 1-2 days

Gram Stain - GPCC
  • Cannot distinguish S. aureus from CNS in Gram stain.
    • Does the staphylococci in the positive blood culture represent true infection or contamination?
    • When to discontinue therapy for CNS contamination?
  • Conventional culture and phenotypic identification can take an additional 1-3 days.
  • Patients with true S. aureus and CNS bacteremia may not receive adequate antibiotic coverage
 
 

PNA FISH® Solution

Rapid Identification and Differentiation of S. aureus from CNS

S. aureus and CNS
  • 90 min. molecular identification and differentiation of S. aureus from CNS directly from positive blood culture.
  • Aid in early identification of true staphylococcal bacteremia.
  • Proven to help:
    • Reduce overall mortality rates both in the ICU and outside the ICU.(8,9)
    • Trend towards shortening length of stay by 2 days for all patients with GPCC-positive blood cultures.(8,9)
 
 

Proven Benefits

Shorten Time to Identification and Differentiation of S. aureus from CNS

Retrospective study of Pre-PNA FISH period (May 2008 - 78 patients) and Post-PNA FISH period (May 2009 - 88 patients) conducted at the Orlando Regional Medical Center (Orlando, FL).(8)
 
 

  • Early identification and notification of S. aureus vs. CNS

  • Improved time to results by 25 hours
 
 
 

Lower Mortality Rates (ICU and non-ICU)

Prospective, randomized, controlled study of 202 patients (101 usual care, 101 notification) with GPCC-positive blood cultures performed at Washington Hospital Center (Washington, D.C.).(9)
 
 

  • Reduced overall mortality rate by 53%

  • Reduced ICU mortality rate by 80%

  • Reduced ICU mortality rate due to S. aureus BSI by 82%
 
 
Retrospective study of Pre-PNA FISH period (May 2008 - 78 patients) and Post-PNA FISH period (May 2009 - 88 patients) conducted at the Orlando Regional Medical Center (Orlando, FL).(8)
   
 

  • 73% reduction in overall mortality rate due to staphylococcal bacteremia

  • 16.7% mortality Pre-PNA FISH vs. 4.5% Post-PNA FISH for all patients with GPCC-positive blood cultures
 
 

Shorten Length of Stay (LOS)

Prospective, randomized, controlled study of 202 patients (101 usual care, 101 notification) with GPCC-positive blood cultures performed at Washington Hospital Center (Washington, D.C.).(9)
 
 

  • Trend toward reduction in overall length of stay by 2 days for all patients with GPCC-positive blood cultures
  
 
Retrospective study of Pre-PNA FISH period (May 2008 - 78 patients) and Post-PNA FISH period (May 2009 - 88 patients) conducted at the Orlando Regional Medical Center (Orlando, FL).(8)
   
 

  • Trend toward overall reduction in length of stay by median 2 days

  • Trend toward 4 days reduction in length of stay for patients with Coagulase-Negative Staph and no risk factors
 
 
 
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3.  MMWR 44(RR12);1-13 Date: Sep 22, 1995
4.  Poster D-787.  ICAAC 2009. San Francisco, CA
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6.  Infec. Control Hosp Epidemiol. 2009 Nov;30(11):1057-61
7.  Clin Infect Dis. 2009 Aug 1;49(3):325-7
8.  Poster 1023.  IDSA 2010.  Vancouver, BC, Canada
9.  Ther Clin Risk Manag. 2008 Jun;4(3):637-40