Abstract

Background: Bloodstream infections caused by drug-resistant pathogens are associated with significant morbidity and mortality, making timely initiation of effective antimicrobial therapy essential. The BioFire® BCID2 panel enables rapid identification of organisms and resistance genes within 1–3 hours, improving time to optimal therapy compared to conventional methods. Despite this, delays in initiating active therapy may still occur. This project aimed to evaluate time to active antimicrobial therapy following BCID2 panel results and identify workflow gaps to inform stewardship interventions.

Methodology: This retrospective, multisite quality improvement project from October 2024 – July 2025, that included adult patients with positive BCID2 results for select Gram-positive organisms (MRSA, VRE), Gram-negative organisms (A. baumannii, P. aeruginosa, S. maltophilia and Enterobacterales with at least one resistance gene detected (CTX-M, KPC, IMP, NDM, VIM, OXA-48-like)), and yeast such as C. auris, C. albicans, C. glabrata C. krusei and Cryptococcus neoformans/gattii. Patients were excluded if they were already receiving active antimicrobial therapy at the time of BCID2 result, pregnant, or had suspected contaminants. The primary outcome was the time from BCID2 result publication to administration of the first dose of active antimicrobial therapy, with delays defined as initiation occurring more than 4 hours after result publication. Secondary outcomes included time from blood culture collection to administration of active antimicrobial therapy; time intervals from BCID2 result to antimicrobial ordering, pharmacy verification, and drug administration; and Infectious Diseases (ID) consultation within 24 hours. Additional outcomes assessed were pharmacy-led antimicrobial optimization following BCID2 results, hospital length of stay (LOS), and 30-day all-cause in-hospital mortality. This study was deemed exempt by the Institutional Review Board.

Results: Of 323 patients screened, 150 patients with positive BCID2 results were included. The median time from result to administration of active antimicrobial therapy was 3 hours (IQR 2–8), with delays observed in 42% of patients, most commonly associated with ESBL-producing Escherichia coli. Patients with delayed therapy had a median time to active antimicrobial administration of 8 hours (IQR 5–13) compared to those without delays (2 hours [IQR 1–3]). Median time from blood culture collection to active therapy was 20 hours (IQR 16–28). For the whole cohort, median time from BCID2 result to antimicrobial ordering was 2 hours (IQR 1–5), followed by 0.1 hours (IQR 0 – 0.03) from antimicrobial ordering to pharmacy verification, and 1 hour (IQR 1–2) from verification to administration. ID consultation occurred before BCID2 resulted in 41% of cases, within 24 hours in 51%, after 24 hours in 7%, and was absent in 1%. Pharmacist intervention to initiate antimicrobial therapy occurred in 54% of patients. Median hospital LOS was 8 days (IQR 5–14) and 30-day in-hospital mortality was 6%.

Conclusion: In adults with multidrug-resistant bloodstream infections identified through rapid molecular testing, delays greater than 4 hours to initiate effective antimicrobial therapy occurred in 42% of cases, most frequently among CTX-M producing Escherichia coli, without a clear impact on clinical outcomes.

Publication Date

Spring 5-14-2026

Presented At:

Florida Residency Conference

Content Type

Presentation

Resident/Fellow

Gladimarys Grajales Aviles, PharmD

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