Antimicrobial Stewardship and Rapid Diagnostic Testing Bundle for Local Management of Gram-Negative Bloodstream Infections
Year: 2015
Type: article
Abstract: Background. Appropriate empirical antimicrobial therapy is associated with improved outcomes of patients with Gram-negative bloodstream infections (GN BSI). However, excessive use of broad-spectrum antimicrobials is not without major adverse events. This quasi-experimental cohort study evaluated the combined impact of antimicrobial stewardship interventions and rapid diagnostic testing on adequacy of empirical therapy for GN BSI and utilization of broad-spectrum antimicrobials. Methods. Adult patients with GN BSI at Palmetto Health Hospitals in Columbia, SC were identified in the pre- (January 2010–December 2013) and post-implementation (January 2014–April 2015) periods. Interventions comprising institutional management guidelines, prospective antimicrobial stewardship monitoring of GN BSI, matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) and FilmArray Blood Culture Identification Panel (BCID). Logistic regression and Kaplan-Meier analysis were used to examine adequacy of empirical therapy and duration of antimicrobial therapy, respectively. Results. A total of 1104 patients with GN BSI were included, 830 pre- and 274 post-implementation. Post-implementation there was a decrease in utilization of combination antimicrobial therapy (13% post versus 27% pre, p < 0.001) and anti-pseudomonal therapy (76% versus 82%, p = 0.01). Interventions were associated with increased adequacy of empirical antimicrobial therapy overall (95% versus 91%, odds ratio [OR] 1.8, 95% confidence intervals [CI] 1.0-3.3). This finding was more profound in subgroups of BSI due to Pseudomonas aeruginosa or chromosomally-mediated AmpC-producing Enterobacteriaceae (97% versus 87%, OR 4.1, 95% CI 1.2-26.5) and Pitt bacteremia scores ≥4 (98% versus 90%, OR 6.5, 95% CI 1.3-117.4). Post-intervention, time to de-escalation off anti-pseudomonal β-lactams (2.6 versus 3.5 days, p < 0.001), carbapenems (2.3 versus 3.7 days, p < 0.001), and combination therapy (1.6 versus 2.7 days, p < 0.001) was decreased. Conclusion. Implementation of antimicrobial stewardship and rapid diagnostic interventions was associated with improved adequacy of empirical antimicrobial therapy for GN BSI while also showing a decrease in utilization of broad-spectrum antimicrobials. Disclosures. J. A. Justo, Cempra Pharmaceuticals: Scientific Advisor, Consulting fee; P. B. Bookstaver, Forest Laboratories: Grant Investigator and Scientific Advisor, Consulting fee; H. Albrecht, Gilead: Investigator and Scientific Advisor, Research grant
Source: Open Forum Infectious Diseases
Authors: Elizabeth Nimmich, Thomas Smith, Julie Ann Justo, P. Brandon Bookstaver, Katie Hammer, Joseph Kohn, Helmut Albrecht, Majdi Al-Hasan
Language: English
Subfield: Applied Microbiology and Biotechnology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2290752994