Evaluation of time to antibiotic therapy after implementation of an updated rapid diagnostic test for gram-negative bacteremia
In brief
Rapid PCR panel trims effective antibiotic start to 1 hour versus 4
In a single-center before-after study of 180 adults with gram-negative bloodstream infections, the updated BCID2 multiplex PCR cut median time to effective therapy from four hours to one hour, and halved the delay for ESBL-producing bugs. Mortality and length of stay were unchanged, leaving the clinical impact on outcomes uncertain.
- Journal
- Journal of clinical microbiology (Q1)
- Published
- 31 August 2026
- Study design
- Non-randomized / quasi-experimental trial
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Rawan Hussein, Leslie Lee, Rajat Nog, Donald Chen, Vishnu Chaturvedi, Nicholas Feola
- PMID
- 42671186
- DOI
- 10.1128/jcm.00328-26
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 1 September 2026): BCID2 reduces time to effective therapy in GN‑BSI
- Picked for Microbiology (medical) (paper of the day, 1 September 2026): Rapid diagnostic test impact on gram‑negative bacteremia therapy
Abstract
UNLABELLED: Rapid pathogen identification optimizes antibiotic therapy in bacteremia and can be achieved through molecular-based diagnostic tests. This study assesses the clinical impact after the implementation of an updated multiplex PCR panel (BIOFIRE Blood Culture Identification 2, BCID2). This single-center, retrospective, quasi-experimental study compared outcomes in adult patients with gram-negative bloodstream infections (GN-BSIs) pre and post BCID2 implementation. Data were collected from 1 March 2022 to 1 March 2024. Patients were included if they were ≥18 years of age, had a gram-negative organism identified by the panels, and received ≥48 h of antibiotics. The primary outcome was time to effective antimicrobial therapy; secondary outcomes included time to appropriate therapy, 30-day mortality, and hospital length of stay. A total of 180 patients were included (90 per BCID and BCID2 groups). Baseline characteristics were similar: median age 62 years, mostly non-critically ill, Charlson Comorbidity Index 4, and Pitt Bacteremia score 1 in both groups. Median time to effective therapy was reduced in the BCID2 vs BCID group (1 vs 4 h, P = 0.004) as well as time to appropriate therapy (25 vs 49 h, P = 0.627). In the ESBL subgroup, BCID2 significantly reduced time to effective therapy (0.5 vs 3 h, P = 0.006) and time to appropriate therapy (16 vs 44 h, P = 0.016). There was no significant difference in mortality (6.7% vs 8.9%, P = 0.756) or length of stay (10 vs 14 days, P = 0.134) between BCID and BCID2 groups. The implementation of BCID2 significantly reduced time to effective therapy in GN-BSIs, particularly among resistant organisms. IMPORTANCE: This study evaluated the impact of transitioning from BCID to BCID2 panel in gram-negative bloodstream infections to address gaps in resistance detection and assess whether expanded molecular diagnostics improve time to antibiotic therapy and clinical outcomes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.