I recently observed two examples that clearly illustrate how molecular technology can enhance patient care. Two different patients had blood cultures positive for multiple organisms. Use of the FilmArray Blood Culture Identification panel (Biofire Diagnostics, LLC) identified these organisms by species the same day their blood cultures turned positive. Furthermore, valuable susceptibility information was available the same day based on detection of resistance genes including van A/B (vancomycin-resistant enterococcus).

One of the patients was bacteremic with two different Gram-negative enterics plus vancomycin-susceptible enterococcus. Conventional testing would only have demonstrated a Gram-negative rod along with Gram-positive cocci by stain the day the culture became positive. Full identification would not have been available for 1 to 2 more days, with vancomycin susceptibility results unknown for 2 to 3 days.

The second patient was bacteremic as well as fungemic with both vancomycin-resistant enterococcus and Candida albicans. Only the enterococcus was visible by Gram stain, so that conventional testing would have missed the yeast initially. Additionally, the yeast did not grow on the culture plates for four days, which would have further delayed appropriate anti-fungal therapy.

These case studies demonstrate the clinical value of new molecular technology in targeting appropriate antimicrobial therapy and initiating isolation precautions sooner.


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