IMPORTANCE: Global deaths attributable to antimicrobial resistance are rising. Hence, rapid susceptibility testing is essential for timely antibiotic de-escalation to mitigate antimicrobial resistance (AMR) development from exposure to broad-spectrum antibiotics. Compared to the costly advanced technology, direct disk diffusion from blood culture (diffusion antibiotic susceptibility testing [dAST]) is an affordable method that can be quickly adopted. However, the reliability of dAST in informing susceptibility was mainly reported from Western countries and scarcely from other regions, including Southeast Asia, where the AMR burden is high. This study from Malaysia adds insights into the performance of dAST and the potential to apply it in similar resource-limited settings from the same region. Furthermore, assessing the dAST's influence on antibiotic prescribing identifies the gap in implementation to guide areas of improvement for optimizing clinical utility.
AIMS: This project aimed to review the impact on antimicrobial treatment and clinical outcome in the NICU setting, of the introduction of the Xpert MRSA/SA BC test (Cepheid, USA) for the identification of staphylococci in blood cultures.
METHODS: A retrospective audit was carried out of the pre- and post-intervention periods; the intervention was the introduction of the Xpert MRSA/SA BC test.
RESULTS: In total, 88 neonates had positive blood cultures with Staphylococcus spp., comprising 42 neonates in the pre-intervention and 46 in the post-intervention groups. The pre-intervention group had a higher birth weight (1.541 kg vs. 1.219 kg, p = 0.05) and higher platelet count (288 vs. 224 × 109/L, p = 0.05). There was a trend towards a shorter duration of antimicrobial therapy in term infants and in the length of admission; however, this was not statistically significant (p = 0.2). All of the nine infants post-intervention with significant bacteraemia (S. aureus =3, CoNS =6) were changed to the optimal antimicrobial at the time the result was available.
CONCLUSIONS: This study shows that the introduction of the Xpert MRSA/SA BC test can lead to a reduction in the length of admission and duration of antimicrobials in term infants; however, the difference was not statistically significant. All nine infants with clinically significant bacteraemia were treated with the appropriate antimicrobial when the Xpert MRSA/SA BC test result was available.