Optimal Pathogen - Directed Therapy using the MALDI TOF in Pediatrics
Kenice Ferguson-Paul1,2,3, Xinhua Yu4, Bindiya Bagga1,2, Sandra R Arnold1,2.
1Department of Pediatrics,Division of Infectious Diseases, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA,
2Le Bonheur Children’s Hospital, Memphis, Tennessee, USA,
3Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA,
4Department of Epidemiology, University of Memphis, Memphis, Tennessee, USA.
Background: Our objective was to determine the effect of the MALDI TOF on time to optimal antimicrobial therapy in bloodstream infections (BSI) compared to conventional methods.
Methods: We reviewed all positive blood cultures from February 2012-2014. The control group (CG) had pathogen identification using conventional methods and the intervention group (IG) with MALDI-TOF.
Results: There were 199 cultures (CG, n=121, IG, n=78). The median time to species identification (hours) for the CG was 48, interquartile range (IQR) 37-57 vs. IG=17, IQR 14-23 (median difference 31, 95% Confidence Interval (CI) -38 to -25). Median time to optimal therapy (hours) for the CG was 28, IQR 2-64 vs. IG= 14.5, IQR 3-55 (median difference -13.5, 95% CI -31-13). By Cox regression MALDI TOF was not associated with reduced time to optimal therapy (hazard ratio (HR) 1.2, p=0.64).
Conclusions: Species level identification is faster with MALDI TOF in BSI but does not allow for faster time to optimal antimicrobials.

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