Clinical utility of direct disk diffusion testing in guiding antibiotic therapy for Gram-negative bacteremia

Abstract

<p>Objective<br>Conventional antibiotic susceptibility testing (AST) for bloodstream infections requires -48 hours, often delaying optimal therapy. We investigated the clinical impact of implementing direct disk diffusion testing (dDDT) for Gram-negative bacteremia.<br>Methods<br>This retrospective cohort study compared patients with Gram-negative bacteremia before (n = 212) and after (n = 214) dDDT implementation. The primary outcome, 30-day mortality, was assessed using the Kaplan-Meier method, a Kolmogorov-Smirnov test, and a multivariate Cox proportional hazards model, with logistic regression for sensitivity analysis. Secondary analyses on therapy appropriateness and the antibiotic spectrum index (ASI) were performed using a mixed-design ANOVA.<br>Results<br>dDDT reduced the mean time to susceptibility results by 24 hours (37.6 ± 14.3 hours vs. 61.6 ± 16.3 hours hours). Post-implementation, the appropriateness of therapy for multidrug-resistant organisms (MDROs) significantly improved from 76.5% to 91.2% (P = 0.048). ASI analysis confirmed these changes were driven by appropriate escalation for MDROs and de-escalation for non-MDROs. Kaplan-Meier analysis showed lower cumulative mortality post-dDDT (P = 0.023), but dDDT was not an independent predictor of 30-day mortality in multivariate analysis (aHR 1.27, 95% CI 0.76-2.14).<br>Conclusions<br>dDDT implementation significantly shortens time-to-results and improves antibiotic appropriateness, facilitating timely stewardship. While a trend towards lower mortality was observed, dDDT was not an independent predictor of survival, highlighting the multifactorial nature of patient outcomes.<br>Summary<br>Direct disk diffusion testing (dDDT) for Gram-negative bacteremia significantly shortens susceptibility reporting, improves antibiotic appropriateness, and may guide antibiotic stewardship. While a trend towards lower mortality was observed, dDDT was not an independent predictor of survival in this study.<br></p>