A Single-center, Quasi-experimental Study to Evaluate the Impact of a Multiplex Polymerase Chain Reaction System Combined with Antimicrobial Stewardship Intervention on Time to Targeted Therapy in Patients with Suspected Central Nervous System Infection

Abstract

BackgroundEmpiric treatment for central nervous system (CNS) infections consists of coverage with multiple antimicrobial agents that may be continued until a pathogen can be identified. Identification may take significant time to result, leading to extended durations of multiple antimicrobial agents, delays in targeted therapy and subsequent adverse effects, such as nephrotoxicity and Clostridium difficile infection. A multiplex polymerase chain reaction (PCR) system that can identify 14 pathogens responsible for community-acquired CNS infections in 1 hour was recently FDA-approved for cerebrospinal fluid (CSF) analysis. The objective of this study was to determine the effect of this PCR paired with antimicrobial stewardship (AMS) team intervention on the time to targeted therapy.MethodsDuring the intervention (Int) phase (January 25, 2017–April 30, 2017), all PCR results were called to the AMS team, who reviewed clinical data and provided antimicrobial recommendations per pre-determined protocol. Recommendations consisted of de-escalation or addition of therapy. The pre-intervention (PI) group consisted of patients with CSF culture obtained between January 25, 20116 and April 30, 2016.ResultsA total of 138 patients were evaluated; 46 in the Int group and 92 in the PI. Of the 46 patients in the Int group, 25 had a negative PCR result and were never initiated on antimicrobials. One patient required antimicrobial escalation. Twenty patients were started on empiric therapy and were candidates for de-escalation. In the PI group, there were no patients with CSF cultures that required therapy escalation, while 33 patients were initiated on empiric antimicrobials. Results from the subgroup of patients in whom empiric therapy was started as shown in Table 1.ConclusionImplementation of a multiplex PCR with AMS intervention resulted in decreased time to targeted therapy.This project was funded through a competitive stewardship grant provided by Merck & Co.Table 1.Preintervention (n = 33)Intervention (n = 21) P-valueTime to targeted therapy, hours, mean ± SD30.8±38.215.4±13.90.06Average antimicrobial days of therapy per patient-days admitted1.64±1.60.52±0.0 < 0.05Time to organism identification, hours, mean ± SD119.6±25.03.9±1.3 < 0.05Disclosures S. Revolinski, Merck: Grant Investigator, Research grant; J. N. Wainaina, Merck: Grant Investigator, Research grant; A. Huang, Merck: Grant Investigator, Research grant