Evaluating the Clinical Impact of the BCID2 Panel and Antimicrobial Stewardship in Pediatric Bloodstream Infections: A Pragmatic Trial in Guatemala

Background: Multiplex polymerase chain reaction panels improve outcomes for bloodstream infections in high-income countries, but little is known in low- and middle-income countries, where there are high rates of antimicrobial resistance and mortality. Methods: We conducted a pragmatic clinical trial in children at a public hospital in Guatemala comparing the impact of a multiplex polymerase chain reaction panel to conventional microbiologic methods. The BioFire Blood Culture Identification (BCID2) panel was performed with antimicrobial stewardship advice on positive blood cultures from midnight to 1 pm on weekdays as the intervention. Children with positive cultures outside these times served as the control group. Time-to-optimal antimicrobial therapy was the primary outcome measure. All-cause mortality was a secondary outcome. Results: A total of 246 children were enrolled from April 2022 to October 2022: 135 in the BCID2 and 111 in the control group. The most common pathogens were coagulase-negative Staphylococcus (54%) and Klebsiella pneumoniae (11%). There was a significant reduction in median time-to-optimal antimicrobial therapy from 97·9 (0–252.3) hours to 31·5 (0–157.1) hours ( P = 0.03) in the control versus BCID2 groups. There was a trend for reduction in overall mortality from 18% (20 deaths) in the control to 10% (14 deaths) in the BCID2 group ( P =0.08). Subanalysis of children with Gram-negative sepsis revealed a 62% reduction in mortality with 14 (25%) deaths in the control group compared with 4 (9·5%) deaths in the BCID2 group ( P = 0.05). Conclusions: Use of BCID2 with antimicrobial stewardship significantly reduces time-to-optimal antimicrobial therapy in low- and middle-income countries like Guatemala, with a significant reduction in mortality due to Gram-negative bacteremia.