Written by Natalie Betz
University of Iowa Hospitals & Clinics is one of the first hospitals in the country to adopt a new technology, the Accelerate Pheno, that helps diagnose and treat sepsis—a potentially life-threatening infection in the blood—faster than ever before.
The machine is simple to use: Bacteria from a blood sample that was grown and observed with a microscope is put into the machine, and a button is pressed. The machine then makes its diagnoses, determining bacterial species with colored DNA probes, and pairing the identification with the appropriate antibiotic testing. This rapid diagnostic technology provides results in just five to seven hours.
“Sepsis is associated with a high mortality rate. This technology will help us identify the organisms, and which antibiotics will be effective. Then we make sure we are giving an effective antibiotic to the patient as soon as possible,” explains Dilek Ince, MD, clinical associate professor of internal medicine and infectious diseases at the UI Carver College of Medicine. “We’re excited to be early adopters of this new technology,” she adds.
Before the Accelerate Pheno, the process to test blood for sepsis could take up to three days to properly diagnose and decide which antibiotic would work best. Most of that time involved growing the bacteria in a petri dish, a process that takes several days. In the meantime, the patient would be given broad-spectrum antibiotics, which could lead to antibiotic resistance.
According to the Centers for Disease Control and Prevention, antibiotic resistance is a major threat for this decade. Bacteria can develop resistance when they are exposed to antibiotics that don’t kill them quickly and efficiently. Using broad-spectrum antibiotics that may not be well matched to the bacteria that are actually present, can increase the risk of antibiotic resistance. The longer bacteria are exposed to ineffective antibiotics, the higher the likelihood of developing resistance becomes. As a result, commonly used antibiotics can become less effective at killing the bacteria that cause disease, which can prove fatal.
“Every hour counts,” explains Bradley Ford, MD, PhD, medical director of the UI Carver College of Medicine Clinical Microbiology Unit and UI principal investigator of a clinical trial of the device. “Traditional testing is growth-based and takes one to three days after the culture turns positive to return a result. This typically means that patients get more drugs, and more broad-spectrum drugs for longer than they would ideally need.”
With the new FDA approved technology, the same data can be generated in six hours in most cases. Most often this means that patients can receive narrower, targeted therapy, but may also catch cases of unexpected antibiotic resistance faster. Waiting less time for results means that patients are likely to return home sooner.
“We can provide concrete, actionable information to our antimicrobial stewardship team who can work with the primary team to optimize therapy. If a culture turns positive they also know to expect results in a short, defined time period rather than the one to three days of uncertainty they had with older culture-based approaches,” Ford says.
The stewardship team, which includes Ince, Pat Kinn, PharmD, and Kelly Percival, PharmD, receive the results from the machine and move towards optimizing the antibiotic therapy for the patient, whether that is adjusting to catch bug-drug mismatches or narrowing antibiotics to limit unnecessary antibiotic exposure.
“We’re one of the first using it, which is really interesting and exciting,” Ford says.“There are very few things the microbiology laboratory can do where we can go from taking a few days to taking six hours. It’s really a game-changer.”