Outpatient Antimicrobial Stewardship Intervention Targeting Cytomegalovirus (CMV) Viremia in Solid Organ Transplant (SOT) Recipients

Abstract

BackgroundThere is a demand for stewardship implementation and research in ambulatory and SOT populations. Few studies focus on outpatient stewardship interventions, and none has focused on timely recognition of CMV in outpatient SOT recipients. This study sought to determine the effect of real-time CMV result notification paired with pharmacist intervention on virologic and clinical outcomes in outpatient SOT recipients.MethodsQuasi-experimental study comprised of two 6-month phases. In the pre-intervention phase, pharmacists were not involved in management of outpatient CMV viremia. In the intervention phase, pharmacists received real-time email notification of positive blood CMV results for review and intervention as necessary. The primary endpoint was rate of viremia eradication at 21 days from therapy initiation. Secondary endpoints: time to antiviral initiation and viremia eradication, rate of CMV invasive disease and hospital admission, and adverse drug events.Results88 of 213 screened patients were included in the primary analysis (n = 49 and 39 in the pre-intervention and intervention groups, respectively). Baseline characteristics were similar, including transplant type (34% vs. 41% liver, 24% vs. 28% kidney, 14% vs. 17% lung, 14% vs. 10% heart), CMV serostatus (53% vs. 64% D+/R-), and maintenance immunosuppression. A total of 73 recommendations were made with 89% acceptance. Baseline CMV viral load >10,000 IU/mL occurred in 12 (24%) vs. 6 (15%) patients (P = 0.29). Of treated patients, 42 (85%) vs. 32 (82%) achieved CMV eradication at 21 days (P = 0.64), 10 (20%) vs. 5 (12%) required admission for CMV management (P = 0.35), 7 (14%) vs. 3 (7%) developed CMV invasive disease (P = 0.50), and 29 (60%) vs. 25 (66%) received antiviral within 5 days (P = 0.61). There were no statistically significant differences in time to antiviral initiation (45 vs. 41 hours; P = 0.64) or viremia eradication (19 vs. 18 days; P = 0.44).ConclusionCMV eradication at 21 days was not significantly different between groups; however, fewer patients in the intervention experienced elevated baseline viral load, CMV invasive disease, and hospital admission. These secondary endpoints suggest possible benefit from the intervention and warrant further characterization and study.Disclosures All authors: No reported disclosures.