Impact of antimicrobial stewardship and rapid microarray testing on patients with Gram-negative bacteremia

2017 ◽  
Vol 36 (10) ◽  
pp. 1879-1887 ◽  
Author(s):  
K. R. Rivard ◽  
V. Athans ◽  
S. W. Lam ◽  
S. M. Gordon ◽  
G. W. Procop ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Gram Negative ◽  
Gram Negative Bacteremia

scholarly journals Evaluation of the impact of the Accelerate Pheno™ system on time to result for differing antimicrobial stewardship intervention models in patients with gram-negative bloodstream infections

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Gerald Elliott ◽  
Michael Malczynski ◽  
Viktorjia O. Barr ◽  
Doaa Aljefri ◽  
David Martin ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Bloodstream Infections ◽  
Standard Of Care ◽  
Resistance Mechanisms ◽  
Gram Negative ◽  
Intervention Models ◽  
Gram Negative Bacteremia ◽  
Potential Impact ◽  
Potential Clinical Impact ◽  
The Impact

Abstract Background Initiating early effective antimicrobial therapy is the most important intervention demonstrated to decrease mortality in patients with gram-negative bacteremia with sepsis. Rapid MIC-based susceptibility results make it possible to optimize antimicrobial use through both escalation and de-escalation. Method We prospectively evaluated the performance of the Accelerate Pheno™ system (AXDX) for identification and susceptibility testing of gram-negative species and compared the time to result between AXDX and routine standard of care (SOC) using 82 patient samples and 18 challenge organisms with various confirmed resistance mechanisms. The potential impact of AXDX on time to antimicrobial optimization was investigated with various simulated antimicrobial stewardship (ASTEW) intervention models. Results The overall positive and negative percent agreement of AXDX for identification were 100 and 99.9%, respectively. Compared to VITEK® 2, the overall essential agreement was 96.1% and categorical agreement was 95.4%. No very major or major errors were detected. AXDX reduced the time to identification by an average of 11.8 h and time to susceptibility by an average of 36.7 h. In 27 patients evaluated for potential clinical impact of AXDX on antimicrobial optimization, 18 (67%) patients could potentially have had therapy optimized sooner with an average of 18.1 h reduction in time to optimal therapy. Conclusion Utilization of AXDX coupled with simulated ASTEW intervention notification substantially shortened the time to potential antimicrobial optimization in this cohort of patients with gram-negative bacteremia. This improvement in time occurred when ASTEW support was limited to an 8-h coverage model.

Automated Alerts Coupled with Antimicrobial Stewardship Intervention Lead to Decreases in Length of Stay in Patients with Gram-Negative Bacteremia

2014 ◽  
Vol 35 (2) ◽  
pp. 132-138 ◽  
Author(s):  
Jason M. Pogue ◽  
Ryan P. Mynatt ◽  
Dror Marchaim ◽  
Jing J. Zhao ◽  
Viktorija O. Barr ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Antimicrobial Stewardship ◽  
Positive Blood Culture ◽  
Medical Center ◽  
Intervention Group ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Appropriate Therapy ◽  
The Impact

Objective.To assess the impact of active alerting of positive blood culture data coupled with stewardship intervention on time to appropriate therapy, length of stay, and mortality in patients with gram-negative bacteremia.Design.Quasi-experimental retrospective cohort study in patients with gram-negative bacteremia at the Detroit Medical Center from 2009 to 2011.Setting.Three hospitals (1 community, 2 academic) with active antimicrobial stewardship programs within the Detroit Medical Center.Patients.All patients with monomicrobial gram-negative bacteremia during the study period.Intervention.Active alerting of positive blood culture data coupled with stewardship intervention (2010-2011) compared with patients who received no formalized stewardship intervention (2009).Results.Active alerting and intervention led to a decreased time to appropriate therapy (8 [interquartile range (IQR), 2-24] vs 14 [IQR, 2-35] hours; P = .014) in patients with gram-negative bacteremia. After controlling for differences between groups, being in the intervention arm was associated with an independent reduction in length of stay (odds ratio [OR], 0.73 [95% confidence interval (CI), 0.62-0.86]), correlating to a median attributable decrease in length of stay of 2.2 days. Additionally, multivariate modeling of patients who were not on appropriate antimicrobial therapy at the time of initial culture positivity showed that patients in the intervention group had a significant reduction in both length of stay (OR, 0.76 [95% CI, 0.66-0.86]) and infection-related mortality (OR, 0.24 [95% CI, 0.08-0.76]).Conclusions.Active alerting coupled with stewardship intervention in patients with gram-negative bacteremia positively impacted time to appropriate therapy, length of stay, and mortality and should be a target of antimicrobial stewardship programs.

scholarly journals 2006. Evaluation of Rapid Blood Culture Identification with Antimicrobial Stewardship Treatment Recommendations at a Community Health System in Patients with Gram-negative Bacteremia: Adequacy, Adherence, and Outcomes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S673-S674
Author(s):  
Erin Deja ◽  
Jeremy J Frens
Keyword(s):  
Blood Culture ◽  
Antimicrobial Stewardship ◽  
Treatment Algorithm ◽  
Resistance Mechanism ◽  
Treatment Recommendations ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Adequate Coverage ◽  
Culture Identification ◽  
Organism Identification

Abstract Background Sepsis mortality is greatly affected by the timely receipt of appropriate antibiotics. FilmArray Blood Culture Identification (BCID) is used at Cone Health to identify organisms in blood cultures within one to 2 hours after growth detected. The Cone Health antimicrobial stewardship (AMS) team has created treatment recommendations for each organism and resistance mechanism identifiable by BCID. Results and antibiotic recommendations are communicated in real time to providers by clinical pharmacists. The purpose of this evaluation was to validate the adequacy of antibiotics recommended by the BCID treatment algorithm for Gram-negative rods (GNR); assess proper implementation of the BCID notification procedure; and evaluate its effect on AMS. Methods Patients with GNR BCID results in January and April 2018 were retrospectively identified. Information collected for each patient included: demographics, location, organism, admission antibiotics, pharmacist compliance with BCID procedure, recommendation acceptance rate, organism susceptibility, changes to antibiotics post-BCID and final cultures, extended-spectrum β-lactamase (ESBL) incidence, length of antibiotic therapy, and patient outcome. Results A total of 101 patients were evaluated. The BCID treatment algorithm recommendations covered 97% of identified organisms (Figures 1–4). Resistant isolates were ESBL producers. Pharmacist antibiotic recommendations matched the treatment algorithm 66% of the time. Providers accepted 90% of pharmacist recommendations. Twenty-two percent of antibiotics were not de-escalated after BCID results without identifiable reason. Conclusion The BCID treatment algorithm provided adequate coverage for nearly all identified organisms, except ESBLs. However, patients with ESBL organisms all survived to hospital discharge. Pharmacists are following the BCID protocol in a majority of cases. One-third of recommendations deviated from the algorithm but only 17% did not have documented reasoning. Providers are very receptive to pharmacist input, with only 8% of recommendations rejected without documented reasoning. Finally, nearly a quarter of empiric antibiotics were not de-escalated despite organism identification, which represents opportunity for improvement. Disclosures All authors: No reported disclosures.

scholarly journals 169Rapid Testing using Verigene® Microarray in Combination with Antimicrobial Stewardship Intervention in Gram-negative Bacteremia

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S80-S80
Author(s):  
Jacqueline T. Bork ◽  
Surbhi Leekha ◽  
Emily Heil ◽  
Rilwan Badamas ◽  
J. Kristie Johnson
Keyword(s):  
Antimicrobial Stewardship ◽  
Gram Negative ◽  
Gram Negative Bacteremia

scholarly journals Impact of Antimicrobial Stewardship and Rapid Microarray Testing on Patients With Gram-Negative Bacteremia

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Kaitlyn Rivard ◽  
Vasilios Athans ◽  
Simon Lam ◽  
Steven Gordon ◽  
Gary Procop ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Gram Negative ◽  
Gram Negative Bacteremia

Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia

2014 ◽  
Vol 69 (3) ◽  
pp. 216-225 ◽  
Author(s):  
Katherine K. Perez ◽  
Randall J. Olsen ◽  
William L. Musick ◽  
Patricia L. Cernoch ◽  
James R. Davis ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Rapid Diagnostics ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Gram Negative Bacteremia

Impact of Two Different Antimicrobial Stewardship Methods on Frequency of Streamlining Antimicrobial Agents in Patients with Bacteremia

2016 ◽  
Vol 38 (1) ◽  
pp. 89-95 ◽  
Author(s):  
Jennifer Lukaszewicz Bushen ◽  
Jimish M. Mehta ◽  
Keith W. Hamilton ◽  
Shawn Binkley ◽  
Daniel R. Timko ◽  
...  
Keyword(s):  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Medical Service ◽  
Antimicrobial Agents ◽  
Academic Medical Center ◽  
Prior Authorization ◽  
Prospective Audit ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Audit Period

OBJECTIVETo assess the likelihood of antimicrobial streamlining between 2 antimicrobial stewardship methods.DESIGNRetrospective cohort study.SETTINGLarge academic medical center.METHODSFrequency and time to antimicrobial streamlining were compared during a prior authorization and a prospective audit period. Streamlining was defined as an antimicrobial change to a narrower agent if available or to a broader agent if the isolate was resistant to empiric therapy. Patients included were ≥18 years old with monomicrobial bacteremia with S. aureus, Enterococcus spp., or any aerobic Gram-negative organism.RESULTSA total of 665 cases of bacteremia met inclusion criteria. Frequency of streamlining was similar between periods for all cases of bacteremia (audit vs restriction: 60.7% vs 53.2%; P=.12), S. aureus bacteremia (73.2% vs 76.9%; P=.671), and Enterococcus bacteremia (81.6% vs 71.9%; P=.335). Compared to restriction, the audit period was associated with an increased frequency of streamlining for cases of Gram-negative bacteremia (51.4% vs 35.6%; odds ratio [OR], 1.85; 95% confidence interval [CI], 1.06–3.25), those on the medical service (67.9% vs 53.1%; OR, 1.86; 95% CI, 1.09–3.16), and those admitted through the emergency department (71.6% vs 51.4%; OR, 2.32; 95% CI, 1.24–4.34). Characteristics associated with increased streamlining included: absence of β-lactam allergy (P<.001), Gram-negative bacteremia (P<.001), admission through the emergency department (P=.001), and admission to a medical service (P=.011).CONCLUSIONSCompared with prior authorization, prospective audit increased antimicrobial streamlining for cases of Gram-negative bacteremia, those admitted through the emergency department, and those admitted to a medical but not surgical service.Infect Control Hosp Epidemiol 2016:1–7

scholarly journals Impact of an antimicrobial stewardship bundle for uncomplicated gram-negative bacteremia

2019 ◽  
Author(s):  
Reaghan M Erickson ◽  
Brandon J Tritle ◽  
Emily S Spivak ◽  
Tristan T Timbrook
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Group Versus ◽  
Antibiotic Use ◽  
Total Hospital Cost ◽  
Short Treatment ◽  
Process Measures ◽  
Gram Negative ◽  
Stewardship Program ◽  
Gram Negative Bacteremia

Abstract Background Recent studies in gram-negative bacteremia (GNB) suggest intravenous (IV) to oral (PO) switch and short treatment durations yield similar clinical outcomes and fewer adverse events. Antimicrobial stewardship program (ASP) bundled initiatives have been associated with improved clinical outcomes for blood stream infections. Methods This single-center retrospective cohort evaluation included inpatient adults from 11/2014-10/2015 and 10/2017-9/2018 with GNB. The pre-ASP period was prior to the establishment of an ASP program. In the post-period, the ASP promoted IV to PO switches, avoidance of repeat blood cultures, and short treatment durations for patients with uncomplicated GNB. The primary outcome was duration of antibiotic therapy. Secondary outcomes included associated process measures with the bundle and clinical outcomes. Results 137 patients met criteria for inclusion, with 51 patients in the pre- group, and 86 patients in the post- group. Background characteristics were similar between groups. The median duration of therapy was 14 days (IQR = 10-16) in the pre- group and 10 days (7-14) in the post- group (p<0.001). The median day of IV to PO switch was on day 5 (4-6) in the pre- group versus day 4 (3-5) in the post- group (p=0.046). Average total hospital cost per case decreased by 27% in the post- group (p=0.19). Mortality rates and bacteremia recurrence were not significantly different between groups. Conclusions An ASP bundle for uncomplicated GNB was associated with reduced durations of therapy and earlier PO switch. These findings highlight the synergistic role of ASPs in optimizing antibiotic use and promoting patient safety.

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