Impact of Multiplex Polymerase Chain Reaction Technology with Antimicrobial Stewardship Interventions in the Management of Patients with Positive Blood Cultures

Abstract

BackgroundTraditional blood culture identification methods often lead to delayed time to optimal antimicrobial agents. This delay may increase morbidity and mortality. Rapid diagnostic tests decrease time to organism identification. The BioFire FilmArray®, a multiplex Polymerase Chain Reaction (mPCR) technology, was implemented at CHI Memorial in October 2016. We aimed to evaluate the tool’s blood culture identification panel in conjunction with antimicrobial stewardship (AS) on improving the management of patients with blood stream infections.MethodsDuring the post-mPCR period, the AS team received real-time notifications of blood culture results via a pager system, reviewed available patient data, and made recommendations to the primary service as necessary. A retrospective chart review was conducted in adult inpatients with positive blood cultures from November 1, 2015 to December 31, 2015 (pre-mPCR period) and November 1, 2016 to January 31, 2017 (post-mPCR period). The primary endpoint was the time to effective and de-escalated antimicrobial therapy in the pre- and post-mPCR periods. Secondary endpoints included differences in pre- and post-mPCR periods in the time to pathogen identification, adverse drug reactions, Clostridium difficile infections, length of stay, in-hospital mortality, 30-day readmission and antimicrobial costs.ResultsA total of 149 patients were included; 77 in the pre-mPCR and 72 in the post-mPCR period. The median age was 70 years, 30% of patients were admitted to ICU, most common source of infection was urinary tract and most common organisms were Escherichia coli and Staphylococcus aureus. There were more patients with sepsis in the post-mPCR group. Time to pathogen identification was significantly reduced from 68.7 to 34.1 hours (P < 0.01). Median times to effective and de-escalated therapy were also significantly reduced from 5.8 to 3.8 hours (P = 0.04) and 73.6 to 36.3 hours (P < 0.01), respectively. No significant differences in secondary outcomes were noted between groups.ConclusionmPCR blood culture identification tool combined with antimicrobial stewardship leads to faster time to effective and de-escalated antimicrobial therapy.Disclosures All authors: No reported disclosures.