Effect of biofire blood culture identification 2 (BCID2) panel versus a matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) rapid incubation protocol on time to optimal therapy in patients with positive blood c

Rapid diagnostic technology (RDT) is a valuable tool that can be used to optimize antimicrobial therapy for patients with bloodstream infections. Several technologies for rapid organism identification exist including matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) and the BioFire® Blood Culture Identification 2 (BCID2) Panel. This multicenter, retrospective, cohort study compared results from patients with a positive blood culture, in which primary identification was performed via a rapid incubation MALDI-TOF protocol (Rapid MALDI-TOF MS) compared to the BCID2 molecular identification Panel. The primary outcome was time to optimal therapy (TTOT). A total of 221 patients were included (Rapid MALDI-TOF MS = 117; BCID2 Panel = 104). Utilization of the BCID2 Panel compared to Rapid MALDI-TOF MS significantly reduced overall TTOT (21.1 h vs. 41.1 h, p < 0.01). This significant reduction in TTOT with the BCID2 Panel was observed with gram-negative bacteremia (4 h vs. 37 h, p < 0.01) and gram-positive bacteremia (17.8 h vs. 41.1 h, p < 0.01), but was not statistically significant for blood cultures deemed contaminants (42 h vs. 43.5 h, p = 0.58). Time to effective therapy (TTET) was improved with the BCID2 Panel although not statistically significant (1.5 h vs. 7.5 h, p = 0.06). No differences were observed with hospital length of stay or clinical failure. Utilization of the BCID2 Panel significantly decreased time to optimal antimicrobial therapy compared to Rapid MALDI-TOF MS for patients with positive blood cultures.