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Antimicrobial Agents and Chemotherapy, October 2008, p. 3558-3563, Vol. 52, No. 10
0066-4804/08/$08.00+0     doi:10.1128/AAC.00283-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Peptide Nucleic Acid Fluorescent In Situ Hybridization for Hospital-Acquired Enterococcal Bacteremia: Delivering Earlier Effective Antimicrobial Therapy

Graeme N. Forrest,^1* Mary-Claire Roghmann,² Latoya S. Toombs,^3, Jennifer K. Johnson,⁴ Elizabeth Weekes,^3, Durry P. Lincalis,⁴ and Richard A. Venezia⁴

Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland,¹ Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland,² Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland,³ Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland⁴

Received 29 February 2008/ Returned for modification 22 May 2008/ Accepted 22 July 2008

Hospital-acquired vancomycin-resistant enterococcal bacteremia has been associated with increased hospital costs, length of stay, and mortality. The peptide nucleic acid fluorescent in situ hybridization (PNA FISH) test for Enterococcus faecalis and other enterococci (EFOE) is a multicolor probe that differentiates E. faecalis from other enterococcal species within 3 h directly from blood cultures demonstrating gram-positive cocci in pairs and chains (GPCPC). A quasiexperimental study was performed over two consecutive years beginning in 2005 that identified GPCPC by conventional microbiological methods, and in 2006 PNA FISH was added with a treatment algorithm developed by the antimicrobial team (AMT). The primary outcome assessed was the time from blood culture draw to the implementation of effective antimicrobial therapy before and after PNA FISH. The severity of illness, patient location, and empirical antimicrobial therapy were measured. A total of 224 patients with hospital-acquired enterococcal bacteremia were evaluated, with 129 in the preintervention period and 95 in the PNA FISH period. PNA FISH identified E. faecalis 3 days earlier than conventional cultures (1.1 versus 4.1 days; P < 0.001). PNA FISH identified Enterococcus faecium a median 2.3 days earlier (1.1 versus 3.4 days; P < 0.001) and was associated with statistically significant reductions in the time to initiating effective therapy (1.3 versus 3.1 days; P < 0.001) and decreased 30-day mortality (26% versus 45%; P = 0.04). The EFOE PNA FISH test in conjunction with an AMT treatment algorithm resulted in earlier initiation of appropriate empirical antimicrobial therapy for patients with hospital-acquired E. faecium bacteremia.

Published ahead of print on 28 July 2008.

Present address: Washington Hospital Medical Center, Washington, DC.

Present address: Rocky Mountain Poison and Drug Center, Denver, CO.