Implementation of multiplex PCR-based blood culture identification among hospitalized pediatric patients at a tertiary care center

Conventional blood culture is the gold standard for pathogen identification for patients with sepsis, but its lengthy turnaround time—encompassing initial bottle incubation and subsequent phenotypic testing—may delay appropriate therapy. The multiplex PCR-based BIOFIRE Blood Culture Identification 2 (BCID2) panel enables earlier pathogen identification and improves patient outcomes. This study aimed to assess the impact of implementing the BCID2 panel versus conventional culture methods on clinical and microbiological outcomes in hospitalized pediatric patients. This case-control cohort study included 150 retrospective and 150 prospective hospitalized patients with positive blood cultures evaluated via parallel BCID2 and conventional culture. The antibiotic stewardship program (ASP) team provided antimicrobial recommendations based on BCID2 results, with final treatment decisions deferred to the attending physicians. Time to targeted therapy was calculated from the initial antibiotic dose—or blood culture collection if the patient was already on antibiotics—to the start of targeted antimicrobial therapy. The median age in the BCID2 group was significantly higher than the pre-BCID2 group, 2.8 vs 1.7 years, respectively ( P = 0.032). While 18 pathogens among the 150 BCID2 cases (12%) were not identified due to being off-panel targets, BCID2 results prompted antimicrobial modification in 28.8% of the remaining cases (38/132). Median time to targeted therapy was 17.0 hours (IQR 9.6–34.2) with BCID2 group versus 24.2 hours (IQR 16.3–52.2) with conventional culture ( P = 0.014). On multivariable logistic regression analysis, the BCID2 intervention remained an independent and significant predictor of achieving rapid antimicrobial optimization (aOR 2.68; 95% CI 1.17–6.14; P = 0.019). BCID2 implementation paired with an active ASP optimizes antimicrobial use in pediatric bacteremia through accelerated targeted therapy. However, a negative BCID2 result requires nuanced clinical interpretation due to the possible presence of off-panel pathogens or rare genotype–phenotype discrepancies.

IMPORTANCE

Bloodstream infection (BSI) remains a leading cause of pediatric morbidity and mortality worldwide. While conventional blood culture is the gold standard, its lengthy turnaround time often delays life-saving therapy. Rapid diagnostic testing (RDT), such as the BIOFIRE Blood Culture Identification 2 (BCID2) panel, is now recommended alongside antimicrobial stewardship programs (ASPs) to optimize clinical management. Our study demonstrates that implementing multiplex PCR-based RDT significantly improves patient outcomes by accelerating the time to targeted therapy. Furthermore, the integration of RDT into an ASP was associated with a significant reduction in both 30-day mortality and hospital length of stay. In conclusion, RDT-guided stewardship serves as both a vital diagnostic tool and a clinical engine that transforms the management of pediatric BSI.