Randomized controlled diagnostic trial to assess dRAST time to result and its utility for antimicrobial stewardship recommendation in bacteremic patients
Abstract
Bloodstream infections cause great mortality and morbidity. Real-time microbiological information has been shown to have an impact on prognosis when combined with an antimicrobial stewardship (AMS) program. dRAST is a rapid commercial antimicrobial susceptibility testing (AST) system based on real-time microscopy. The primary outcome of this trial was to compare positive blood culture's time-to-result (TTR), defined as time from Gram stain to AST report, between dRAST and our standard of care in a real-life clinical setting. Secondary outcomes included microbiological concordance, time to antimicrobial stewardship recommendation (TAMS), and time to change antimicrobial prescription (TCAP) in agreement with AMS recommendation. We performed a prospective, open-label, randomized (1:1) diagnostic clinical trial comparing dRAST and our standard of care commercial MicroScan broth microdilution (MBMD) (MicroScan-Walkaway, Beckman-Coulter, USA) in 277 hospitalized patients with bacteremia. Categorical and continuous variables were compared by chi-squared and Mann-Whitney U tests, respectively. Median TTR, TAMS, and TCAP were 25, 28, and 29 hours in the MBMD group, and 9, 11, and 13 hours in the dRAST group, respectively. For gram-negative bacilli, essential agreement (EA) was 93.6%, categorical agreement (CA) 93.2%, very major error (VME) 14%, major error (ME) 3%, and minor error (mE) 1.4%. For gram-positive cocci, EA was 93.7%, CA 92.8%, VME 0%, ME 7.6%, and mE 1.8%. dRAST is a…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 277 participants or records.
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