Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/16124
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dc.contributor.authorEmonet, Stephane-
dc.contributor.authorCharles, Patrick G P-
dc.contributor.authorHarbarth, Stephan-
dc.contributor.authorStewardson, Andrew J-
dc.contributor.authorRenzi, Gesuele-
dc.contributor.authorUckay, Ilker-
dc.contributor.authorCherkaoui, Abdessalam-
dc.contributor.authorRougemont, Mathieu-
dc.contributor.authorSchrenzel, Jacques-
dc.date2016-07-27-
dc.date.accessioned2016-08-12T06:26:57Z-
dc.date.available2016-08-12T06:26:57Z-
dc.date.issued2016-07-27-
dc.identifier.citationClinical Microbiology and Infection 2016; online first: 27 Julyen_US
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/16124-
dc.description.abstractOBJECTIVES: Empiric therapy of methicillin-susceptible Staphylococcus aureus (MSSA) with vancomycin is associated with poorer outcome than targeted therapy with beta-lactams. Our objective was to evaluate if rapid determination of methicillin resistance shortens the time from Gram stain to targeted antimicrobial therapy in staphylococcal bacteraemia, thereby reducing vancomycin overuse. METHODS: Single-center open parallel RCT. Gram positive cocci in clusters positive blood culture underwent real-time PCR for rapid species and methicillin resistance determination parallel to conventional microbiology. Patients were randomized 1:1 so that clinicians would be informed of PCR results (intervention group) or not (control group). RESULTS: 89 patients (intervention 48, control 41) were analysed. MRSA was identified in 7 patients, MSSA in 46 and CoNS in 36. PCR results were highly concordant (87/89) with standard microbiology. Median time (hours) from Gram stain to transmission of methicillin-susceptibility was 3.9 (2.8-4.3) vs. 25.4 (24.4-26-7) in intervention vs. control groups (p< 0.001). Median time (hours) from Gram stain to targeted treatment was similar for "all staphylococci" [6 (3.8-10) vs. 8 (1-36) p = 0.13] but shorter in intervention group when considering S. aureus only [5 (3-7) vs. 25.5 (3.8-54) p<0.001]. When standard susceptibility testing complete, 41/48 (85.4%) patients in intervention group were already receiving targeted therapy compared to 23/41 (56.1%) in control group (p=0.004). There was no significant effect on clinical outcomes. CONCLUSIONS: Rapid determination of methicillin resistance in staphylococcal bacteraemia is accurate and reduces significantly the time to targeted antibiotic therapy in the subgroup of S. aureus, thereby avoiding unnecessary exposure to vancomycin.en_US
dc.subjectAntimicrobial stewardshipen_US
dc.subjectMethicillin resistanceen_US
dc.subjectMolecular diagnosisen_US
dc.subjectRapid microbiologyen_US
dc.subjectStaphylococcal bacteraemiaen_US
dc.subjectTargeted treatmenten_US
dc.titleRapid molecular determination of methicillin resistance in staphylococcal bacteraemia improves early targeted antibiotic prescribing: a randomized clinical trialen_US
dc.typeJournal Articleen_US
dc.identifier.journaltitleClinical Microbiology and Infectionen_US
dc.identifier.affiliationAustin Health, Heidelberg, Victoria, Australiaen_US
dc.identifier.affiliationDivision of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerlanden_US
dc.identifier.affiliationBacteriology Laboratory, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerlanden_US
dc.identifier.affiliationDepartment of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australiaen_US
dc.identifier.affiliationDepartment of General Medicine, Austin Health, Heidelberg, Victoria, Australiaen_US
dc.identifier.affiliationGenomic Research Laboratory, Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerlanden_US
dc.identifier.pubmedurihttps://pubmed.ncbi.nlm.nih.gov/27475737en_US
dc.identifier.doi10.1016/j.cmi.2016.07.022en_US
dc.type.contentTexten_US
dc.type.austinJournal Articleen_US
local.name.researcherCharles, Patrick G P
item.fulltextNo Fulltext-
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.openairetypeJournal Article-
item.grantfulltextnone-
item.cerifentitytypePublications-
crisitem.author.deptGeneral Medicine-
crisitem.author.deptInfectious Diseases-
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