Outcomes of Rapid Identification of Multi-Drug Resistant Gram-Negative Organisms Causing Bacteremia in Combination with Antimicrobial Stewardship in a Community Health System.

Abstract

BackgroundRapid initiation of effective antibiotic therapy has been strongly associated with a decrease in mortality in gram-negative (GN) bacteremia. In an effort to improve time to effective antibiotic therapy in the treatment of multi-drug resistant (MDR) GN bacteremia, we implemented Verigene GN Blood Culture (BC-GN) assay, which can rapidly identify GN bacteria at the genus/species level and specific resistance markers from blood cultures within 2 hours of positivity.MethodsThe objective of this multi-center, pre-post quasi-experimental study was to assess outcomes of Verigene BC-GN in combination with antibiotic stewardship in treatment of MDR GN bacteremia. A retrospective chart review was performed one year prior and four months post-implementation of Verigene BC-GN. Patients > 18 years old with MDR GN bacteremia identified by Verigene BC-GN within 5 days of admission were included. The primary endpoint was time to effective antibiotic therapy for MDR GN bacteremia. Secondary outcomes included overall and ICU length of stay (LOS) and 30-day mortality. Education regarding interpretation of resistance markers and selection of optimal antibiotic therapy was provided to pharmacists and physicians prior to implementation.ResultsA total of 110 patients were included, 86 in the pre-intervention group and 24 in the post-intervention group. Mean time to effective antibiotic therapy decreased significantly from 47.6 ± 23.1 vs. 18.8 ± 9.1 hours, respectively (P < 0.0001). Median overall LOS was 6.0 vs 5.5 days (P = 0.88), ICU LOS was 3.0 vs 4.0 days (P = 0.57), and 30-day mortality was 4.7% vs 4.2% (P = 1) pre and post-implementation, respectively.ConclusionVerigene BC-GN, in combination with antibiotic stewardship, successfully improved time to effective antibiotic therapy among MDR GN organisms causing bacteremia.Disclosures All authors: No reported disclosures.