Abstract
PurposeGram-negative bacteria (GNB) are a leading cause of bloodstream infections (BSI) and management is complicated by antibiotic resistance. The Accelerate Pheno™ system (ACC) can provide rapid organism identification and antimicrobial susceptibility testing (AST).MethodsA retrospective, pre-intervention/post-intervention study was conducted to compare management of non-critically ill patients with GNB BSI before and after implementation of a bundled initiative. This bundled initiative included dissemination of a clinical decision algorithm, ACC testing on all GNB isolated from blood cultures, real-time communication of results to the Antimicrobial Stewardship Program (ASP), and prospective audit with feedback by the ASP. The pre-intervention period was January 2018 through December 2018, and the post-intervention period was May 2019 through February 2020.ResultsSeventy-seven and 129 patients were included in the pre-intervention and post-intervention cohorts, respectively. When compared with the pre-intervention group, the time from Gram stain to AST decreased from 46.1 to 6.9 h (p < 0.001), and the time to definitive therapy (TTDT) improved from 32.6 to 10.5 h (p < 0.001). Implementation led to shorter median total duration of antibiotic therapy (14.2 vs 9.5 days; p < 0.001) and mean hospital length of stay (7.9 vs 5.3 days; p = 0.047) without an increase in 30-day readmissions (22.1% vs 14%; p = 0.13).ConclusionImplementation of an ASP-bundled approach incorporating the ACC aimed at optimizing antibiotic therapy in the management GNB BSI in non-critically ill patients led to reduced TTDT, shorter duration of antibiotic therapy, and shorter hospital length of stay without adversely affecting readmission rates.
Highlights
Gram-negative bacteria (GNB) are predominant causes of bloodstream infections (BSI), and management is complicated by increasing antibiotic resistance [1,2,3,4,5]
During the pre-intervention and post-intervention periods, 121 and 241 patients with GNB BSI were initially identified by microbiology laboratory records, respectively (Fig. 1)
Our Antimicrobial Stewardship Program (ASP)-bundled intervention incorporating the Accelerate PhenoTM system (ACC) to optimize antibiotic utilization in the management of noncritically ill patients with GNB BSI was associated with improved time to ID and antimicrobial susceptibility testing (AST), time to definitive therapy (TTDT), and shorter duration of antibiotic therapy
Summary
Gram-negative bacteria (GNB) are predominant causes of bloodstream infections (BSI), and management is complicated by increasing antibiotic resistance [1,2,3,4,5]. The current standard technique for the diagnosis of BSI is via detection of bacteria from automated blood culture systems and subsequent detection of resistance using agar plates and semi-automatic equipment. This may take 2–4 days, during which time patients may be receiving inappropriate antibiotic therapy. The rapid diagnosis of BSI can improve patient care and foster effective antimicrobial stewardship by allowing optimal targeted therapy to be deployed rapidly [6,7,8]. Newer rapid diagnostic testing (RDT) can significantly reduce the time to actionable results and allow optimization of therapy within hours of development of sepsis as opposed to a several day delay
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