BCID Education

8/12/2019 BCID Education

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Film Array Blood Culture

Identification PanelAntimicrobial Stewardship: Jared Olson

and Emily Thorell

Hillary Crandall and Anne BlaschkePCH Micro Lab: Mandy Dickey


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What it is BCID?

Nucleic acid based assay (multiplex PCR)

Simultaneous detection of bacterial, yeast and

resistance gene targets

Performed directly on positive blood cultures

Sensitivity >97% (usually near 100%)

Specificity >99%


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Targets


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What it is missing?

Susceptibilities

Anaerobes

Some less common pathogens


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When it is done?

First positive aerobic blood culture only

Immediately after culture become positive

Subsequent positive cultures only gram stainis done

If gram stain is different BCID will be done


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Workflow and Timeline

BCX into BACTEC BCX +

MD/LIP called:

Gram Stain

MD/LIP called:

Gram Stain andBCID

45-60

minutes

< 90

minutes

hours to days

Susceptibilities

24 hours

Susceptibilities

Help2:

FISH: Staph &

Enterococcus

ID and mecA

Help2:

Confirmatory IDon Select

Organisms

24 hours

45 minutes

24 hours

24 hours


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How is it reported?

BCID negative reported as gram stain only BCID negative will be reported by Tech

BCID delayed, gram stain called to MD/LIP

In progress will be verbally reported by Tech BCID result called when complete


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Genus Only Assays

Detects multiple species

Enterococcus spp.

PrimarilyE. fecalis and E. faecium plus

E. gallinarum and E. casseliflavus

Streptococcus spp.

Common Streptococcus spp., and Viridans GroupStrep including S. anginosus, S. mitis/oralis, S.

constellatus, S. intermedius, S. bovis, S. mutans, etc. S. pyogenes (group A), S. agalactiae (group B) and S.

pneumoniaereported individually only


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Genus Only Assays

Staphylococcus spp. Coagulase negative Staphylococcus

Reported as Staphylococcus species, verbal report will saymost often CONS

Some CONS are NOT detected by the PCR

S. aureus reported individually only

Enterobacteriaceae Citrobacter, Salmonellaetc.

E. cloacae, E. coli, K. oxytoca, K. pneumoniae, S.marscescensand Proteusreported individually

Rare enteric gram negatives will be missed


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Resistance Genes

Resistance can occur by multiple mechanisms thus absenceof these genes does not always indicate susceptibility

mecAmethicillin resistance Will be present if CoNS is detected but

Only reported if Staphylococcus aureus positive vanA/Bvancomycin resistance

Only reported if Enterococcuspositive

KPC - Klebsiella pneumoniaecarbapenemase Rare at PCH

Possibly produced by many gram negative organisms K. pneumoniae, K. oxytoca, E. coli, Enterobacter, P. aeruginosa,

Acinetobacter spp., S. marcescens

Only reported if gram negative organism is detected


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Multiple Organisms

If multiple organisms are detected then all will

be reported, if they correlate with gram stain

Multiple organism infection within a genus

maybe reported as a single organism

EXAMPLE:

Growing both E. fecalis and E. faecium

reported as Enterococcus

Growing both Citrobacterand E. colireported

as E. coli only


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Summary

BCID can give rapid identification of pathogens

Potential to tailor antibiotic therapy quickly

Results are not as complete as traditional

microbiologic techniques

Carefully consider the clinical situation of each patient

Call with questions

Micro Lab - 662-2141

ID fellow or attending

Antimicrobial stewardship (8 am to 5 pm)


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CLINICAL CASE #1

18 mo male admitted with hMPV pneumonia. Febrile in ED and BCX

obtained. Requiring 6 L via HFNC. You are called with a critical value

BCX: gram + cocci in clusters, what do you do?


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Clinical Case #1

BCX: gram + cocci in

clusters, what do you do?

Repeat BCX Antibiotics: vancomycin

BCX: gram + cocci in

clusters, Staphylococcusspp. DNAD, what do you

do?

Repeat BCX Antibiotics: ??

18 mo male admitted withhMPV pneumonia. Febrile

in ED and BCX obtained.

Requiring 6 L via HFNC.

You are called with a

critical value


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CLINICAL CASE #2

40 day old previously healthy male admitted with fever.

WBC 4.5k (20% bands)

CSF: 1 WBC, 5 RBCUA: 5 WBC, 10 RBC, 1+ ketones

RFA: rhinovirus +

What do you do?


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Clinical Case #2

What do you do?

Antibiotics: ceftriaxone

Duration: 48 hours

BCX: gram + cocci in chains,

what do you do?

Antibiotics:

BCX: gram + cocci in chains,

Enterococcus spp. DNAD,

what do you do? Antibiotics: add ampicillin or

vancomycin

40 day old previouslyhealthy male admitted

with fever.

WBC 4.5k (20% bands)

CSF: 1 WBC, 5 RBC

UA: 5 WBC, 10 RBC, 1+

ketones

RFA: rhinovirus +


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CLINICAL CASE #3

2 yo female ex. 30 week premie with short gut, TPN dependent, fever to40C. BCX obtained, received 80 ml/kg in ED, ceftriaxone per shock

protocol and admitted to PICU, norepi at 0.05 mcg/kg/min.

What do you do?


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Clinical Case #3

What do you do?

What have they grown?

Antibiotics: vancomycin, zosyn or

cef/flagyl BCX: gram - bacilli

Antibiotics: d/c vancomycin ??

BCX: gram - bacilli, E. coli DNAD

Antibiotics: d/c vancomycin??,ceftriaxone only?

What could be missing?Citrobacter, Salmonella

BCX: gram - bacilli,Acinetobacter baumanii DNAD

Antibiotics: meropenem

2 yo female ex. 30 weekpremie with short gut, TPN

dependent, fever to 40C.

BCX obtained, received 80

ml/kg in ED, ceftriaxone

per shock protocol andadmitted to PICU, norepi at

0.05 mcg/kg/min.

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