{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T17:45:32Z","timestamp":1793036732898,"version":"4.5.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,2]]},"abstract":"\n Background:<\/jats:title>\n Implementing matrix-assisted laser desorption ionization\u2013time of flight and multiplex polymerase chain reaction has been associated with decreased mortality and hospital length of stay in adults, but the impact in pediatrics is less understood.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n This pre\u2013post quasi-experimental study compared antibiotic prescribing for positive blood cultures in patients \u226421 years of age collected in 2012 (preintervention) and in 2015 (after matrix-assisted laser desorption ionization\u2013time of flight\/multiplex polymerase chain reaction). Time to effective and optimal antimicrobial therapy was evaluated using Cox proportional hazards regression. Time to ideal optimal therapy was estimated as the earliest potential initiation of optimal therapy. Antibiotic use and clinical outcomes were measured.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n There were 242 and 192 positive monomicrobial blood cultures in 2012 and 2015, respectively. Postintervention, time to optimal therapy (73.8 vs. 48.8 hours; P<\/jats:italic> < 0.001) and organism identification (55.6 vs. 29.5 hours; P<\/jats:italic> < 0.001) were reduced, and patients were more likely to receive optimal therapy by 7 days (hazard ratio, 1.85; P<\/jats:italic> < 0.001). In the ideal scenario in 2015, there was an 8.8-hour delay in initiating optimal therapy based on the time that sufficient microbiologic data were available. Postintervention, time to effective therapy (2.8 vs. 2.7 hours; P<\/jats:italic> = 0.782) and clinical outcomes did not differ. Unnecessary antibiotic duration for probable contaminants (skin flora) (43.1 vs. 29.7 hours; P<\/jats:italic> = 0.027), vancomycin for methicillin-sensitive Staphylococcus aureus<\/jats:italic> (54.0 vs. 41.3 hours; P<\/jats:italic> = 0.008) and nonpenicillin\/ampicillin antibiotics for group A Streptococcus<\/jats:italic>, group B Streptococcus<\/jats:italic> and Enterococcus faecalis<\/jats:italic> (87.2 vs. 33.4 hours; P<\/jats:italic> < 0.001) were reduced postintervention.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Rapid diagnostics reduced time to optimal antimicrobial therapy and unnecessary antibiotic use without worse clinical outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/inf.0000000000002102","type":"journal-article","created":{"date-parts":[[2018,5,10]],"date-time":"2018-05-10T23:32:25Z","timestamp":1525995145000},"page":"131-137","source":"Crossref","is-referenced-by-count":26,"title":["Ideal and Actual Impact of Rapid Diagnostic Testing and Antibiotic Stewardship on Antibiotic Prescribing and Clinical Outcomes in Children With Positive Blood Cultures"],"prefix":"10.1097","volume":"38","author":[{"given":"Caroline H.","family":"Reuter","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Infectious Diseases, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah L.","family":"Palac","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Northwestern University Feinberg School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry K.","family":"Kociolek","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Infectious Diseases, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago"},{"name":"Department of Pediatrics, Northwestern University Feinberg School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaotian T.","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Northwestern University Feinberg School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuf Y.","family":"Chao","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Northwestern University Feinberg School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupal M.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer J.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Infectious Diseases, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago"},{"name":"Department of Pediatrics, Northwestern University Feinberg School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20230912","doi-asserted-by":"crossref","first-page":"4851","DOI":"10.1128\/AAC.00627-10","article-title":"Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis.","volume":"54","author":"Paul","year":"2010","journal-title":"Antimicrob Agents Chemother"},{"key":"R2-20230912","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.amjmed.2006.03.034","article-title":"Benefit of appropriate empirical antibiotic treatment: thirty-day mortality and duration of hospital stay.","volume":"119","author":"Fraser","year":"2006","journal-title":"Am J Med"},{"key":"R3-20230912","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1592\/phco.24.9.896.36101","article-title":"Antimicrobial stewardship programs as a means to optimize antimicrobial use. Insights from the Society of Infectious Diseases Pharmacists.","volume":"24","author":"Owens","year":"2004","journal-title":"Pharmacotherapy"},{"key":"R4-20230912","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1086\/375818","article-title":"A hospitalwide intervention program to optimize the quality of antibiotic use: impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance.","volume":"37","author":"Bantar","year":"2003","journal-title":"Clin Infect Dis"},{"key":"R5-20230912","doi-asserted-by":"crossref","first-page":"e87870","DOI":"10.1371\/journal.pone.0087870","article-title":"Same day identification and full panel antimicrobial susceptibility testing of bacteria from positive blood culture bottles made possible by a combined lysis-filtration method with MALDI-TOF VITEK mass spectrometry and the VITEK2 system.","volume":"9","author":"Machen","year":"2014","journal-title":"PLoS One"},{"key":"R6-20230912","doi-asserted-by":"crossref","first-page":"e62323","DOI":"10.1371\/journal.pone.0062323","article-title":"Multiplex PCR system for rapid detection of pathogens in patients with presumed sepsis - a systemic review and meta-analysis.","volume":"8","author":"Chang","year":"2013","journal-title":"PLoS One"},{"key":"R7-20230912","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1093\/cid\/cis1204","article-title":"Impact of matrix-assisted laser desorption ionization time-of-flight mass spectrometry on the clinical management of patients with Gram-negative bacteremia: a prospective observational study.","volume":"56","author":"Clerc","year":"2013","journal-title":"Clin Infect Dis"},{"key":"R8-20230912","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1093\/cid\/cit498","article-title":"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.","volume":"57","author":"Huang","year":"2013","journal-title":"Clin Infect Dis"},{"key":"R9-20230912","doi-asserted-by":"crossref","first-page":"e32589","DOI":"10.1371\/journal.pone.0032589","article-title":"Direct matrix-assisted laser desorption ionization time-of-flight mass spectrometry improves appropriateness of antibiotic treatment of bacteremia.","volume":"7","author":"Vlek","year":"2012","journal-title":"PLoS One"},{"key":"R10-20230912","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.jinf.2014.05.005","article-title":"Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia.","volume":"69","author":"Perez","year":"2014","journal-title":"J Infect"},{"key":"R11-20230912","first-page":"267","article-title":"Clinical impact and provider acceptability of real-time antimicrobial stewardship decision support for rapid diagnostics in children with positive blood culture results.","volume":"6","author":"Messacar","year":"2017","journal-title":"J Pediatric Infect Dis Soc"},{"key":"R12-20230912","doi-asserted-by":"crossref","first-page":"e134","DOI":"10.1097\/INF.0000000000001065","article-title":"Rapid identification of microorganisms by FilmArray blood culture identification panel improves clinical management in children.","volume":"35","author":"Ray","year":"2016","journal-title":"Pediatr Infect Dis J"},{"key":"R13-20230912","doi-asserted-by":"crossref","first-page":"2849","DOI":"10.1128\/JCM.00682-14","article-title":"Impact of antimicrobial stewardship intervention on coagulase-negative Staphylococcus blood cultures in conjunction with rapid diagnostic testing.","volume":"52","author":"Nagel","year":"2014","journal-title":"J Clin Microbiol"},{"key":"R14-20230912","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1111\/1469-0691.12329","article-title":"Matrix-assisted laser desorption ionization time-of-flight mass spectrometry and PCR-based rapid diagnosis of Staphylococcus aureus bacteraemia.","volume":"20","author":"Clerc","year":"2014","journal-title":"Clin Microbiol Infect"},{"key":"R15-20230912","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1093\/cid\/civ447","article-title":"Randomized trial of rapid multiplex polymerase chain reaction-based blood culture identification and susceptibility testing.","volume":"61","author":"Banerjee","year":"2015","journal-title":"Clin Infect Dis"},{"issue":"suppl 3","key":"R16-20230912","doi-asserted-by":"crossref","first-page":"S134","DOI":"10.1093\/cid\/ciu547","article-title":"Review of rapid diagnostic tests used by antimicrobial stewardship programs.","volume":"59","author":"Bauer","year":"2014","journal-title":"Clin Infect Dis"},{"key":"R17-20230912","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.ajic.2008.03.002","article-title":"CDC\/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting.","volume":"36","author":"Horan","year":"2008","journal-title":"Am J Infect Control"}],"container-title":["Pediatric Infectious Disease Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00006454-201902000-00009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T22:41:32Z","timestamp":1694558492000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00006454-201902000-00009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2]]},"references-count":17,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.1097\/inf.0000000000002102","relation":{},"ISSN":["0891-3668"],"issn-type":[{"value":"0891-3668","type":"print"}],"subject":[],"published":{"date-parts":[[2019,2]]}}}