Impact of Introducing a Multiplex Polymerase Chain Reaction Blood Culture Panel on Anti-Methicillin-Resistant Staphylococcus aureus (MRSA) and Carbapenem Antimicrobial Agents in a Children's Hospital.

Background: With the advent of multiplex polymerase chain reaction (PCR) using samples from a positive blood culture, the time required to identify a pathogen has significantly shortened to a few hours. It can help us select appropriate antimicrobial agents more quickly. The present study aimed to assess the impact of using a multiplex PCR blood culture panel on the appropriate administration of antimicrobial agents.
Methods: Patients aged <16 years with culture-confirmed bacteremia at Tokyo Metropolitan Children's Medical Center were enrolled. A pre-intervention period (period I: December 2016 to December 2018) and a post-intervention period with multiplex PCR use for the confirmation of positive blood cultures (period II: December 2019 to December 2021) were compared for their effect on the use of antimicrobial agents for gram-positive cocci (GPC) and gram-negative rod (GNR) bacteremia. Data on patient background, blood culture results, and antimicrobial use were retrospectively collected from electronic medical records.
Results: Periods I and II had 174 and 154 patients, respectively. The median age at periods I and II was 14 (IQR 2-82) months and 12 (IQR 1-78) months, respectively. GPC bacteremia during periods I and II occurred in 140 and 115 patients, respectively. GNR during periods I and II occurred in 34 and 39 patients, respectively. Neither the vancomycin-resistance genes A/B nor the carbapenem-resistance gene were detected. The use of antimicrobial agents against anti-methicillin-resistant Staphylococcus aureus (MRSA) for GPC bacteremia decreased from 103/140 cases (73%) in period I to 56/115 cases (49%) in period II (p=0.047). The use of carbapenems for GNR bacteremia did not change significantly, at 23/34 (68%) in period I and 34/39 (87%) in period II (p=0.47).
Conclusion: Introducing multiplex PCR for pediatric bacteremia decreased the use of anti-MRSA antimicrobial agents but not of carbapenems.
Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board of Tokyo Metropolitan Children’s Medical Center issued approval 2022b-41. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
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