Table 8.
Antimicrobial Management Based on Clinical Adjudication, According to KT Results
| Characteristic | Effectivenessa | Frequency (%) |
|---|---|---|
| Was the initial antimicrobial treatment efficacious against the microorganisms detected by KT? | Very likely effective | 2/55 (3.6) |
| Definitely effective | 9/55 (16.4) | |
| Likely effective | 10/55 (18.2) | |
| Likely not effective | 8/55 (14.5) | |
| Not applicable | 14/55 (25.5) | |
| Not effective | 12/55 (21.8) | |
| Was antimicrobial treatment at 52 to 100 hours efficacious against the microorganisms detected by KT? | Very likely effective | 3/55 (5.5) |
| Definitely effective | 8/55 (14.5) | |
| Likely effective | 12/55 (21.8) | |
| Likely not effective | 7/55 (12.7) | |
| Not applicable | 14/55 (25.5) | |
| Not effective | 11/55 (20) | |
| Different antimicrobial treatment proposed had KT result been available in real time | No | 29/55 (52.7) |
| Yes | 26/55 (47.3) | |
| Antibiotic | Additionb | 11/55 (20) |
| No change | 33/55 (60) | |
| Withdrawalc | 14/55 (25.5) | |
| Antiviral | Addition | 8/55 (14.5) |
| No change | 47/55 (85.5) | |
| Antifungal | Addition | 2/55 (3.6) |
| No change | 51/55 (92.7) | |
| Withdrawal | 1/55 (1.8) | |
| Not applicable | 1/55 (1.8) | |
| MRSA coverage | Addition | 1/55 (1.8) |
| Withdrawal | 5/55 (9.1) | |
| Not applicable | 49/55 (89.1) | |
| Anaerobe coverage | Addition | 7/55 (12.7) |
| Not applicable | 48/55 (87.3) | |
| Narrowing of antibiotic spectrum | Yes | 8/55 (14.5) |
| Not applicable | 47/55 (85.5) | |
| Broadening of antibiotic spectrum | Yes | 1/55 (1.8) |
| Not applicable | 54/55 (98.2) | |
| Antiviral coverage CMV | Addition | 1/55 (1.8) |
| Not applicable | 54/55 (98.2) | |
| Antiviral coverage HSV | Addition | 7/55 (12.7) |
| Not applicable | 48/55 (87.3) | |
| Antiparasitic coverage | Addition | 1/55 (1.8) |
| Not applicable | 54/55 (98.2) | |
| Antimycobacterial coverage | Addition | 1/55 (1.8) |
| Not applicable | 54/55 (98.2) |
Abbreviations: CMV, cytomegalovirus; HSV, herpes simplex virus; KT, Karius test; MRSA, methicillin-resistant Staphylococcus aureus.
aEffectiveness was adjudicated based on available literature on antimicrobial susceptibility of the microorganism considered.
bIncludes 1 addition of trimethoprim-sulfamethoxazole for coverage of Pneumocystis jirovecii.
cWithdrawal of antibacterials including withdrawal of MRSA coverage (n = 5), narrowing of gram-negative rod coverage (n = 8), and 2 nonspecified cases. In 2 cases, addition and withdrawal of different antibacterials was recommended.