Implémenter le système Alfred60 AST dans un laboratoire clinique : impact clinique sur la prise en charge des patients septiques et analyse financière.

INTRODUCTION: Sepsis is an important cause of morbidity and mortality. An accelerated microbiology diagnosis is crucial in order to reduce the time to initiate targeted antibiotic therapy. The Alfred60AST system is able to provide phenotypic Antimicrobial Susceptibility Testing (AST) results within hours. This study has two objectives: assess the clinical impact of this technology and determine its cost-effectiveness.

METHODS: During a ten weeks period, all new enterobacterial or enterococcal bloodstream infection was analyzed with the Alfred60AST system, in parallel with routine methods. Its impact on the clinician's therapeutic strategy was studied. In order to assess the financial and practical aspects of the method, an analysis of the extracosts and a survey of the technical staff were conducted.

RESULTS: Fifty-three cases of bacteriemia were included. For the Enterobacteriaceae bacteriemias, a clinical impact was shown in 18,9% of the cases (e.g, treatment modification). The financial analysis highlighted an increase in costs (+38% for enterobacteriaceae, +50% for enterococci), compared to the theoretical costs reported by the firm, due to the workflow and the volumes of samples used. Finally, results of the technical staff survey were favorable in terms of ease of use of the system.

CONCLUSION: In addition to its ease of use, the Alfred60AST system is able to provide an AST in a record time. This study shows a real interest of the technic in the therapeutic management of patients with enterobacterial sepsis. However, its routine implementation requires an increase of the analyzed volumes as well as a 24 /7 organization of the laboratory in order to be profitable.