Effect of Direct-from-blood Bacterial Testing on Antibiotics Administration in Adults Presenting With Acute Infection: A Randomized Trial
Year: 2025
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND: For hospitalized adults receiving empiric antibiotic therapy, antibiotic de-escalation prevents unnecessary exposure and adverse effects. Whether use of direct-from-blood bacterial testing facilitates earlier antibiotic de-escalation and improves clinical outcomes has never been evaluated in a randomized trial. METHODS: Between December 2023 and December 2024, this pragmatic randomized trial compared direct-from-blood bacterial testing with blood cultures (intervention group) to blood cultures alone (usual care group) in adults with suspected infection receiving empiric intravenous vancomycin in the emergency department of an academic medical center. The primary and secondary outcomes were time from randomization to last dose of intravenous vancomycin and systemic antipseudomonal beta-lactam antibiotics, respectively. RESULTS: Among 500 patients enrolled, the time from randomization to results of bacterial testing from blood (direct-from-blood test, gram stain, or negative culture) was a median of 5.2 days shorter (95% CI, 5.1-5.2) in the direct-from-blood test group (median 0.4 days; IQR, 0.3-0.5) than the usual care group (median, 5.5 days; IQR, 5.2-5.6). The time between randomization and the last dose of intravenous vancomycin did not differ between the direct-from-blood test group (median, 12.5 hours; IQR, 0.79-57.8) and the usual care group (median, 19.0 hours; IQR 0.9-64.8) (HR, 1.08; 95% CI, .90-1.28; P = .42), nor did the time to last dose of systemic antipseudomonal beta-lactam antibiotics (HR, 1.04; 95% CI .87-1.24). Clinical outcomes were also similar. CONCLUSIONS: Among adults with suspected infection receiving empiric intravenous vancomycin in the emergency department, use of direct-from-blood bacterial testing did not shorten the duration of intravenous vancomycin or antipseudomonal beta-lactam antibiotics.
Source: Clinical Infectious Diseases
DOI: 10.1093/cid/ciaf677
Authors: David C Gaston, Romney M Humphries, Ariel A Lewis, Cheryl L Gatto, Li Wang, George E Nelson, Joanna L Stollings, Benjamin J Ereshefsky, Matthew A Christensen, Mary Lynn Dear, Ritu Banerjee, Matthew Rodgers, Alison Benton, Sharon Glover, Karen F Miller, Wesley H Self, Matthew W Semler, Edward T Qian, Dan Albert, Adrienne Baughman, Laura Bobbitt, Carleigh Burns, Timothy Duff, Andrea Fletcher, Allyson Hobbie, Austin Ing, Jakea Johnson, Gabriel Kemp, Sheryl Mangrum, Geoff Mavrak, Kelly Moser, David Mulherin, Shannon Pugh, Todd W Rice, Chrissie Schaeffer, Adam Turner, Sabrina Shipman, Halden Z VanCleave, Hamilton Wen, LaKeysha Wiggins
Institutions: Vanderbilt University, Vanderbilt University Medical Center
Language: English
Subfield: Applied Microbiology and Biotechnology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: hybrid
Estimated APC paid: $4,763
Funder: National Institutes of Health
OpenAlex ID: W7124425857