BCID2 Implementation and Quality Improvement in a Children’s Hospital

Introduction: Evaluation of pediatric bacteremia with PCR technology is not widely described in medical literature. Epidemiology, blood culture (BC) contamination rates, and collection may pose opportunities for PCR to contribute to pediatric quality improvement (QI) efforts. BIOFIRE® Blood Culture Identification 2 (BCID2; bioMérieux) is a multiplex PCR (detects 26 bacteria, 7 yeast, 10 resistance genes); that was implemented at our children’s hospital in June 2024. BCID2 is performed when BC is positive (VIRTUO Microbial, bioMérieux) in hospitalized patients; BCID2 results are reported to the clinical team as critical values. A QI project was developed to: 1. Evaluate concordance with BCID2 and BC results; 2. Track time to microbe identification; 3. Assess antimicrobial management; 4. Identify additional QI opportunities.


Methods: We reviewed patient records with positive BC from 6/15/24-12/31/24. Data included time of gram stain, BCID result, & blood culture finalization; BC collection location, antibiotic management.


Results: 1,760 BCs were performed; 179 were positive. 18 positive BC were not sent for BCID2: notably, 6 BC from outpatient/ER sites. Three of these six patients returned for repeat BC and further care. The remaining 161 positive BC had 165 organisms. 7 organisms did not have a BCID2 target: Micrococcus l. (4), Acinetobacter r., Leuconostoc m., Rhizobacterium r. BC and BCID2 concordance: 98.1% (155/158); BCID2 missed 1 staphylococcus and 2 streptococcus species. Subsequent positive BC during the same patient admission did not undergo BCID2 if gram stain matched first positive BC. This strategy did not miss new microbes; repeat positive BC agreement: 96.7%; (59/61 microbes; 2 BC yielded contaminants). BCID2 results were available ~30 hours faster than standard BC.


Conclusions: Our pediatric data indicates BCID2 provides accurate results faster than the gold standard for pathogens it is designed to detect; findings similar to adult bacteremia studies. Neonatal research utilizing BCID2 to assess BC before positivity may be applicable in other specific clinical scenarios. QI opportunities identified during this review: 1. Ensure prompt narrowing of antimicrobials; 2. Extend use of BCID2 to outpatient settings; 3. Develop protocols using BCID2 before BC positivity.