The diagnosis and treatment of bloodstream infections remains a significant issue within the hospital environment. There are approximately 100,000 cases of sepsis recorded annually in the UK. These result in 37,000 deaths and a cost to the NHS in the region of £2.5 billion. It is in this context that the management of sepsis formed the subject of a report by the Parliamentary and Healthcare ombudsman in which the importance of rapid diagnosis and treatment was emphasised.
Data from the published literature verifies these conclusions, demonstrating that the risk of death from septic shock increases by the hour unless therapeutic intervention occurs (Kumar et al. Chest. 2009 Nov;136(5):1237-48).
However, the decision as to which antimicrobial agent to prescribe requires the identity of the pathogen species to be ascertained. Traditional methods of pathogen identification from positive blood cultures can take several days, meaning that antibiotic therapy decisions must be based on clinical symptoms or gram stain results only, rather than on a positive identification of a causative organism. This can result in inappropriate therapies being used, or treatment proceeding using broad spectrum antibiotics until definitive species identification can be obtained.
The QuickFISH system overcomes these issues by enabling a positive species identification to be obtained from a positive blood culture in just 20 minutes. This allows the pathogen identity to be reported to the clinician at the same time as the gram stain results. Providing this information permits appropriate antimicrobial therapy to commence promptly, potentially resulting in enhanced patient outcomes. In addition the ability to identify possible misleading contaminants, such as coagulase negative Staphylococci (CNS), allows treatment to be promptly de-escalated where necessary, with attendant resource savings.
Evidence from the literature shows the extent of the benefits that are possible. A study by Ly et al (2008) demonstrated the effect of rapid notification of pathogen identification made possible by PNA technology, when applied to patients with blood cultures positive for gram positive cocci in clusters.
The rapid identification of such Staphylococci to species level, increased survival rates for those with S.aureus, and decreased length of hospital stay for those patients with CNS. In this way patient outcomes were improved, in combination with better use of hospital resources.
1. UK Sepsis Trust: Sepsis Management In Scotland report, NHS Scotland (2010)
2. Daniels R. The incidence, mortality and economic burden of sepsis. (2009) In: NHS Evidence emergency and urgent care.
3. Kumar et al. Chest. 2009 Nov;136(5):1237-48
4. Ly et al. Ther Clin Risk Manag. 2008 Jun; 4(3):637-40