Evaluating the Clinical Impact of the BCID2 Panel and Antimicrobial Stewardship in Pediatric Bloodstream Infections: A Pragmatic Trial in Guatemala.
| Title: | Evaluating the Clinical Impact of the BCID2 Panel and Antimicrobial Stewardship in Pediatric Bloodstream Infections: A Pragmatic Trial in Guatemala. |
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| Authors: | Graff KE; From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.; Galvez N; Department of Pediatrics, Hospital Roosevelt, Calzada Roosevelt, Guatemala City, Guatemala.; Lamb MM; Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.; Cortes R; Microbiology Laboratory, Hospital Roosevelt, Calzada Roosevelt, Guatemala City, Guatemala.; Sanchez Villeda EA; Microbiology Laboratory, Hospital Roosevelt, Calzada Roosevelt, Guatemala City, Guatemala.; Calvimontes DM; Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala.; Melgar MA; Department of Pediatrics, Hospital Roosevelt, Calzada Roosevelt, Guatemala City, Guatemala.; Olson D; Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.; Asturias EJ; Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.; Dominguez SR; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado. |
| Source: | The Pediatric infectious disease journal [Pediatr Infect Dis J] 2025 Nov 01; Vol. 44 (11), pp. 1051-1058. Date of Electronic Publication: 2025 Aug 01. |
| Publication Type: | Journal Article; Pragmatic Clinical Trial |
| Language: | English |
| Journal Info: | Publisher: Williams & Wilkins Country of Publication: United States NLM ID: 8701858 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-0987 (Electronic) Linking ISSN: 08913668 NLM ISO Abbreviation: Pediatr Infect Dis J Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [Baltimore, Md. : Williams & Wilkins, c1987- |
| MeSH Terms: | Antimicrobial Stewardship*/methods ; Anti-Bacterial Agents*/therapeutic use ; Bacteremia*/drug therapy ; Bacteremia*/microbiology ; Bacteremia*/mortality ; Bacteremia*/diagnosis ; Multiplex Polymerase Chain Reaction*/methods ; Blood Culture*/methods; Guatemala/epidemiology ; Humans ; Male ; Female ; Child, Preschool ; Infant ; Child ; Infant, Newborn ; Adolescent |
| Abstract: | Background: Multiplex polymerase chain reaction panels improve outcomes for bloodstream infections in high-income countries, but little is known in low- and middle-income countries, where there are high rates of antimicrobial resistance and mortality.; Methods: We conducted a pragmatic clinical trial in children at a public hospital in Guatemala comparing the impact of a multiplex polymerase chain reaction panel to conventional microbiologic methods. The BioFire Blood Culture Identification (BCID2) panel was performed with antimicrobial stewardship advice on positive blood cultures from midnight to 1 pm on weekdays as the intervention. Children with positive cultures outside these times served as the control group. Time-to-optimal antimicrobial therapy was the primary outcome measure. All-cause mortality was a secondary outcome.; Results: A total of 246 children were enrolled from April 2022 to October 2022: 135 in the BCID2 and 111 in the control group. The most common pathogens were coagulase-negative Staphylococcus (54%) and Klebsiella pneumoniae (11%). There was a significant reduction in median time-to-optimal antimicrobial therapy from 97·9 (0-252.3) hours to 31·5 (0-157.1) hours ( P = 0.03) in the control versus BCID2 groups. There was a trend for reduction in overall mortality from 18% (20 deaths) in the control to 10% (14 deaths) in the BCID2 group ( P =0.08). Subanalysis of children with Gram-negative sepsis revealed a 62% reduction in mortality with 14 (25%) deaths in the control group compared with 4 (9·5%) deaths in the BCID2 group ( P = 0.05).; Conclusions: Use of BCID2 with antimicrobial stewardship significantly reduces time-to-optimal antimicrobial therapy in low- and middle-income countries like Guatemala, with a significant reduction in mortality due to Gram-negative bacteremia.; (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.) |
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| Contributed Indexing: | Keywords: BioFire Blood Culture Identification; antimicrobial stewardship; bloodstream infection; low- and middle-income countries; pediatric sepsis |
| Molecular Sequence: | ClinicalTrials.gov NCT05314816 |
| Substance Nomenclature: | 0 (Anti-Bacterial Agents) |
| Entry Date(s): | Date Created: 20250829 Date Completed: 20251009 Latest Revision: 20251125 |
| Update Code: | 20260130 |
| DOI: | 10.1097/INF.0000000000004937 |
| PMID: | 40880253 |
| Database: | MEDLINE |
Journal Article; Pragmatic Clinical Trial