The value of comprehensive syndromic panels for bloodstream infections

• Bloodstream infections can lead to sepsis, a significant burden to the healthcare industry which contributes to at least 11 million deaths worldwide annually
• Since sepsis care costs are incredibly high, healthcare leaders can leverage multiplexed syndromic panels that can offer clinicians more timely and accurate results
• Syndromic panels that have comprehensive detection of multiple bloodstream pathogens and resistance profiles may offer a better prognosis for patients, increased hospital cost savings, and help address the antimicrobial resistance crisis

Bloodstream infections caused by bacteria or fungi present in the blood can lead to sepsis, the number one cause of hospital deaths, readmissions, and costs in the healthcare industry. With 47 to 50 million sepsis cases per year which contribute to at least 11 million deaths worldwide, there is a significant unmet need for better diagnostic strategies that can aid in targeted treatments  and improve sepsis diagnosis.¹

The earlier that infections causing sepsis are detected, the better the patient’s prognosis may be. Astonishingly, reports show that every hour appropriate antimicrobials are delayed, the risk of sepsis mortality can increase by 8%.² However, the traditional approach for identification of pathogens and antimicrobial susceptibility using blood cultures followed by subculture, while simple and, low cost, may lack sensitivity and specificity for some pathogens and requires multiple days for identification.³ This lengthy process can lead to poor outcomes and even death for patients.

With one death every 2.8 seconds attributed to sepsis, healthcare leaders should consider leveraging a comprehensive molecular approach that incorporates syndromic blood culture identification panels to help clinicians diagnose early and save lives while helping healthcare systems reduce costs.⁴

Any individual can get sepsis, the final cause of death following an infectious disease that arises when the immune system damages a person’s own organs and tissues. 

Groups that have a higher risk of developing sepsis include premature infants, neonates, adults over 60 years old, people with weakened immune systems, or individuals with chronic diseases. In some cases, patients who survive sepsis will likely live with long-term aftereffects, known as post-sepsis syndrome (PSS).⁴ This can lead to chronic depression, muscle weakness, joint pain, confusion, and anxiety.⁴

When we look at the costs, studies have shown that hospital-acquired bloodstream infections can lead to an average of US$ 43,000 for a 10-day stay.⁵ For candidiasis, a fungal infection caused by yeast, costs can be over US$ 150,000, with death rates for fungal disease ranging from 50-70%.⁶

Poor prognosis and high price tag following sepsis represent a significant challenge in healthcare economics, costing US healthcare systems US$ 38 billion each year, rendering the identity of the cause of the infection critical.⁷ Since traditional microbiological methods using blood culture for diagnosing bloodstream infections can take days, tapping into rapid molecular syndromic panels could offer clinicians more timely and accurate results, saving patients lives and hospitals money.⁸

Various microorganisms, including bacteria, fungi, viruses, and parasites, can cause sepsis. Common sources of sepsis include wound infections as well as respiratory, gastrointestinal, and urinary tracts.⁴ Syndromic blood culture identification panels provide rapid and comprehensive blood culture identification diagnostics to detect causative organisms and resistance profiles so clinicians can make informed treatment decisions.⁹

Compared to conventional blood culture identification tests or matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS), these rapid multiplex nucleic acid amplification tests can provide faster results with less turnaround and hands-on time from personnel.^9,10

Characteristics of a high-quality syndromic panel include:^9-11

• Coverage of a broad range of pathogens, including Gram-positive and Gram-negative bacteria, and fungal targets
• Rapid results in minutes due to shorter turnaround times
• Hands-off time for lab personnel
• Identification of blood culture contamination
• Detection of resistance genes

Notable from the above list is the ability of these tests to rule out blood culture contamination rapidly. Contaminants comprise as high as 15-30% of the organisms isolated in specific hospitals, so differentiating between contaminants and infections is vital for antimicrobial treatment.¹² Presence of these targets on a syndromic panel can help ensure accurate identification, reduce costs, and assist with achieving optimal patient management.¹²

According to the World Health Organization (WHO), bacterial antimicrobial resistance is responsible for 1.27 million deaths globally and has contributed to 4.95 million deaths in 2019.¹³ WHO estimates additional healthcare costs will reach US$ 1 trillion by 2050 and an additional US$ 2.4 trillion will be lost in gross domestic product (GDP) each year until 2030.¹³

Antimicrobials are medicines critical for treating infectious diseases and play a key role in treating patients with bloodstream infections. Still, the effectiveness of using antimicrobial treatment can decrease, known as antimicrobial resistance (AMR), due to misuse and overuse, which is why proper detection techniques are essential to ensure patients receive targeted treatment for their infection which may help to reduce the chance of further AMR development.

To help address the AMR crisis, healthcare systems should seek the use of syndromic panels to detect antimicrobial resistance genes to provide information that can help with rapid infection control, deliver targeted therapy faster, and aid in optimal patient care. Beyond offering rapid and accurate results, using syndromic panels for the identification of pathogens responsible for bloodstream infections also provides a means to address the global crisis of AMR.

To improve clinical outcomes for septic patients, healthcare leaders should leverage syndromic panel testing to ensure rapid and reliable diagnosis of pathogens causing bloodstream infections.. Current culture methods cannot provide the reliability, quickness, and accuracy needed to treat patients when time is critical.

Multiplex tests have demonstrated shorter time to results and minimal hands-on time, which can help physicians determine the most optimal therapeutics, reducing the length of stay in hospitals. Because a broad range of pathogens can cause bloodstream infections and sepsis, pinpointing the exact cause will provide the greatest opportunity for a better prognosis, increase hospital cost savings, and address the AMR crisis.