Effect of Rapid Molecular Diagnostic Implementation on Time to Targeted Antibiotic Treatment for Bloodstream Infections: A Before-and-After Study at a Community Teaching Hospital.

Abstract

Purpose: Bloodstream infections (BSIs) require prompt, targeted antimicrobial therapy, but traditional blood culture methods may delay optimal treatment. The BIOFIRE® Blood Culture Identification 2 (BCID2) panel provides rapid pathogen identification and mayreduce time to targeted therapy. This study evaluated the impact of BCID2 implementation at a community teaching hospital. Methods: A retrospective, quasi-experimental pre/post study was conducted at a for-profit community teaching hospital in adults aged ≥18 years with BSIs. Eligible patients had bacteremia, blood cultures collected, and empiric antibiotic therapy initiated during the study periods. Exclusion criteria included pregnancy, detection of multiple pathogens in a single culture, availability of susceptibility results before the designated timeline, and discharge, transfer, or leaving against medical advice before completion of testing. The pre-implementation group included 64 patients (October-December 2023), and the postimplementation group included 60 patients (October 2024-February 2025). The primary outcome was time from blood culture collection to initiation of targeted antibiotic therapy based on final susceptibility results. Secondary outcomes included pathogen identification, empiric and total antibiotic use, and length of stay. Results: The study included 124 patients (mean age, 70.5 ± 17.3 years; 67% ≥65 years; 50% male). Blood cultures were ordered for suspected sepsis/septic shock in 58% of patients and suspected secondary bacteremia in 42%. Pathogen distribution was similar between groups, with Escherichia coli, Staphylococcus epidermidis, Enterococcus faecalis, and Staphylococcus aureus identified most frequently. BCID2 implementation significantly reduced time to optimal therapy (3.73 ± 2.01 vs. 2.02 ± 1.48 days, p<0.001) and empiric antibiotic duration (3.73 ± 2.01 vs. 2.04 ± 1.48 days, p < 0.001). Total antibiotic duration and length of stay did not differ significantly between groups. Conclusion: BCID2 implementation at a community hospital significantly shortened time to optimal therapy and reduced empiric antibiotic use among older hospitalized adults.