Antimicrobial and resource utilization with T2 magnetic resonance for rapid diagnosis of bloodstream infections: systematic review with meta-analysis of controlled studies

ABSTRACT

Objectives: To compare antimicrobial and resource utilization with T2 Magnetic Resonance (T2MR) versus blood culture (BC) in patients with suspected bloodstream infection.

Methods: We systematically searched MEDLINE, EMBASE, and CENTRAL for randomized trials or observational controlled studies of patients with suspected bloodstream infection receiving a diagnosis with T2MR or BC. Using an inverse variance meta-analysis model, we reported mortality using the risk ratio (RR) and the remaining outcomes as the mean difference (MD).

Results: Fourteen studies were included in the meta-analysis. Time to detection (MD = −81 hours; p < 0.001) and time to species identification (MD = −77 hours; p < 0.001) were faster with T2MR. Patients testing positive on T2MR received targeted antimicrobial therapy faster (−42 hours; p < 0.001) and patients testing negative on T2MR were de-escalated from empirical therapy faster (−7 hours; p = 0.02) vs. BC. Length of intensive care unit stay (MD = −5.0 days; p = 0.03) and hospital stay (MD = −4.8 days; p = 0.03) were shorter with T2MR. Mortality rates were comparable between T2MR and BC (28.9% vs. 29.9%, RR = 1.02, p = 0.86).

Conclusion: Utilization of T2MR for identification of bloodstream pathogens provides faster time to detection, faster transition to targeted microbial therapy, faster de-escalation of empirical therapy, shorter ICU and hospital stay, and with comparable mortality rate versus BC.

KEYWORDS:

• Bacteremia
• blood culture
• candida
• magnetic resonance
• sepsis
• T2Dx

Acknowledgments

The authors thank David Fay, Ph.D., for systematic review and data extraction assistance. We also thank Alexander Zoufaly, M.D., and Joshua Templeton, B.S.N., R.N., for providing a critical review of the manuscript.

2.6. Role of the funding source and data availability statement

No funding was received for this study. The manufacturer of the T2Dx device (T2 Biosystems) was not involved in any aspect of this review. The underlying data from this meta-analysis may be made available for research purposes upon receipt of a proposal to the corresponding author in accordance with the National Institutes of Health Data Sharing Policy [44].

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Supplementary material

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Additional information

Funding

This paper was not funded.