Use of organism identification by 16S ribosomal RNA polymerase chain reaction to shorten antimicrobial length of therapy

Background Organism detection by 16S ribosomal RNA (rRNA) PCR followed by amplicon sequencing identification may help guide antimicrobial treatment in culture-negative patients. The objectives of this study were to assess the effect of a positive versus negative 16S rRNA PCR on antibiotic length of therapy (LOT) and rate of antibiotic discontinuation. Methods Patients with a sterile site, direct-specimen 16S rRNA PCR negative, and suspected active infection were matched 1:1 with 16S rRNA PCR positive patients based on specimen site and retrospectively evaluated. Results Ninety patients were included (n = 45 positive and negative). 16S rRNA PCR negative patients had shorter median LOT (33 days [IQR 8–46] versus 43 days [IQR 29–51], P = 0.02). Antibiotics were discontinued more frequently in 16S rRNA PCR negative patients (38% versus 4%, P < 0.01). Conclusions For culture-negative patients with suspected sterile site infection, a negative, direct-specimen 16S rRNA PCR may help discontinue antibiotics and decrease LOT.