Pharmacy Update
Dave Calley
Director of Pharmacy
AMP (Antimicrobial Stewardship Program).
West Valley has some great tools to assist with antimicrobial stewardship:
Biofire rapid diagnostic testing:
BioFire’s film array DNA testing allows clinicians to quickly identify infectious agents drawn from a blood culture within about an hour. The test identifies the specific organism within about an hour, but sensitivities are still reported up to 24 hours later.
West Valley currently has three different Assays available:
1. Blood Culture Identification (BCID) panel.
Blood cultures are triggered automatically whenever a blood culture is positive. No specific order by the provider is necessary. Biofire requires a certain bacterial load to perform its DNA testing, so most samples need to grow for a time before there is enough bacteria to test. Results will be posted up to 70% sooner.
Here are some quick guides to the Biofire rapid DNA results:
- If the result only says “Staph Aureus” then it is considered a Methicillin Sensitive Staph Aureus (MSSA) organism. West Valley has very high sensitivities to both Ancef and Nafcillin. Those would be the agents of choice.
- If the result says “MecA gene positive Staph” then it is a Methicillin Resistant Staph Aureus (MRSA) and would respond only to Vancomycin, Daptomycin, or Linezolid.
- If the result says “VanA/B positive” then it is Vanco-Resistant. (There have been no cases identified at WV yet).
- If it says “KPC” then it is carbapenem-resistant. (Again thankfully no cases at WV).
- The test does not detect ESBL (Extended-Spectrum Beta Lactamase) producing strains. Biofire is working on this. For now, the decision to cover with a broad-spectrum agent (Meropenem, Ertapenem) needs to be based on clinical judgement. Again, specific sensitivities should be produced within 24-48 hours.
More information about Biofire can be found here: https://www.biofiredx.com/products/solutions/for-labs/
2. Meningitis Panel.
The FilmArray meningitis panel tests for a comprehensive set of 14 of the most common bacterial, viral, and fungal pathogens associated with CNS infections In 21 hour using only 0.2ml of fluid. Up to a 96% diagnostic yield for the Biofire panel compared to traditional testing.
- Rapid testing needs to be specifically ordered by the provider.
- Should be used with every tap to guide treatment immediately.
- Identifies bacteria, viruses and Cryptococcus.
3. Respiratory Panel.
The respiratory panel should be reserved when physicians really feel a need to know quickly. The test costs about $700. The test needs to be ordered specifically. It does identify up to 20 pathogens within 60 minutes and has 97.1% sensitivity and 99.3% specificity. It should not however be utilized on a routine basis for all Flu cases.
Targeting the correct antibiotic at the correct dose for the correct duration is vital for patient recovery and safety. Biofire offers a rapid diagnostic tool to guide therapy. As always, the Pharmacy department, Lab, or Dr. Augustus would be glad to assist with any antibiotic question.