48. Association of Rapid Pathogen Identification and Pharmacist Intervention on Time to Optimal Antimicrobial Therapy for Bloodstream Infections at Two Community Hospitals

Abstract Background As many as 1 in 3 patients with bloodstream infections at community hospitals receive inappropriate empiric antimicrobial therapy. Studies have shown that the coupling of real-time intervention with rapid pathogen identification improves patient outcomes and decreases health-system costs at large, tertiary academic centers. The aim of this study was to assess if similar outcomes could be obtained with the implementation of real-time pharmacist intervention to rapid pathogen identification at two smaller, rural community hospitals. Methods This was a pre-post implementation study that occurred from September of 2019 to March 2020. This study included patients ≥18 years of age admitted with one positive blood culture. Patients were excluded if they were pregnant, had a polymicrobial blood culture, known culture prior to admission, hospice consulted prior to admission, expired prior to positive blood culture, or transferred to another hospital within 24 hours of a positive blood culture. Endpoints of patients prior to intervention were compared to patients post-implementation. The primary endpoint was time to optimal antimicrobial therapy. Secondary endpoints included time to effective antimicrobial therapy, in-hospital mortality, length of hospital stay, and overall cost of hospitalization. Results Of 212 patients screened, 88 patients were included with 44 patients in each group. Both groups were similar in terms of comorbidities, infection source, and causative microbial. No significant difference was seen in the mean time to optimal antimicrobial therapy (27.3±35.5 hr vs 19.4± 30 hr, p=0.265). Patients in the post-implementation group had a significantly higher mean hospitalization cost ($24,638.87± $11,080.91 vs $32,722.07±$13,076.73, p=0.013). There was no significant difference in time to effective antimicrobial therapy, in-hospital mortality, or length of hospital stay. Conclusion There were no between-group differences in the primary outcome of time to optimal therapy, with a higher mean hospitalization cost after implementation. These results suggest further antimicrobial stewardship interventions are needed, along with larger studies conducted in the community hospital settings. Disclosures All Authors: No reported disclosures

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Comparison of Pharmacist-Directed Management of Multiplex PCR Blood Culture Results with Conventional Microbiology Methods on Effective and Optimal Therapy within a Community Hospital

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01575-18 ◽

2018 ◽

Vol 63 (1) ◽

Cited By ~ 3

Author(s):

Allison M. Porter ◽

Christopher M. Bland ◽

Henry N. Young ◽

David R. Allen ◽

Sabrina R. Croft ◽

...

Keyword(s):

Blood Culture ◽

Multiplex Pcr ◽

Positive Blood Culture ◽

Antimicrobial Therapy ◽

Community Hospital ◽

Intervention Group ◽

Standard Of Care ◽

Pharmacist Intervention ◽

Coagulase Negative Staphylococcus ◽

Optimal Therapy

ABSTRACT Multiplex PCR combined with a pharmacist-driven reporting protocol was compared to the standard of care within a community hospital to evaluate initial changes after notification of a positive blood culture. The intervention group demonstrated decreased times to changes in antimicrobial therapy (P = 0.0081), increased changes to optimal antimicrobial therapy (P = 0.013), and decreased vancomycin use for coagulase-negative staphylococcus contaminants (P < 0.01) with multiplex PCR implementation and pharmacist intervention.

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Improving Positive Blood Culture Removal Time Significantly Decreases Total Processing Time

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2013-0681-oa ◽

2014 ◽

Vol 139 (2) ◽

pp. 199-203 ◽

Cited By ~ 2

Author(s):

Eric Salazar ◽

Mukul Divatia ◽

Patricia L. Cernoch ◽

Randall J. Olsen ◽

S. Wesley Long ◽

...

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Processing Time ◽

Bloodstream Infections ◽

Blood Cultures ◽

Clinical Microbiology Laboratory ◽

Total Processing Time ◽

Pathogen Identification ◽

Critical Function ◽

Removal Time

Context Timely processing of blood cultures with positive results, including Gram staining and notification of clinicians, is a critical function of the clinical microbiology laboratory. Analysis of processing time in our laboratory revealed opportunities to enhance workflow efficiency. We found that the average time from positive blood culture result to removal of the bottle for processing (positive-to-removal [PR] time) was inadequate for our rapid pathogen identification program. Objective To determine whether increased vigilance about PR time and prioritization of laboratory resources would decrease PR time and total processing time. Design We performed a retrospective analysis of blood culture PR time 7 months before and 7 months after an in-service meeting during which the importance of PR time was emphasized, and corrective measures were implemented. Results Before the in-service meeting, the average PR time for 5057 samples was 38 minutes, with an aggregate time of 192 251 minutes. Unexpectedly, we discovered that only 51.8% (2617 of 5057) of the positive blood cultures were removed in less than 10 minutes. After the in-service meeting, for 5293 samples, the average PR time improved to 8 minutes, the aggregate time improved to 44 630 minutes, and 84.5% (4470 of 5293) of the positive blood cultures were removed in less than 10 minutes. These improvements reduced the time to telephone notification of the Gram stain results to a caregiver by 46.7% (from 105 minutes to 56 minutes). Conclusions Increased awareness of barriers to rapid pathogen identification and interventions for improving performance time significantly enhanced care of patients with bloodstream infections.

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10. The Impact of the Verigene® Gram-positive Blood Culture Panel on the Management of Vancomycin Resistant enterococci Bloodstream Infections in a Multi-site Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa417.009 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S6-S7

Author(s):

Christopher Jackson ◽

Sarah Bandy ◽

Will Godinez ◽

Gerard Gawrys ◽

Grace Lee

Keyword(s):

Cohort Study ◽

Blood Culture ◽

Hospital Mortality ◽

Positive Blood Culture ◽

Clinical Pharmacy ◽

Bloodstream Infections ◽

Vancomycin Resistant ◽

Baseline Characteristics ◽

Secondary Outcomes ◽

The Impact

Abstract Background Vancomycin-resistant Enterococcus (VRE) bloodstream infections (BSIs) are associated with high morbidity and mortality. PCR-based rapid diagnostic tests provide prompt identification of infectious etiologies within hours. This study evaluated the impact of the Verigene® Gram-positive blood culture (GP-BC) panel on the outcomes on patients with VRE BSIs. Methods A multi-center pre- and post-implementation retrospective cohort study was conducted at four large HCA Healthcare facilities. The implementation of Verigene® GP-BC and VigiLanz® surveillance software with real-time notifications to clinical pharmacists occurred in 2015. Adults > 18 years with VRE BSIs were evaluated over two time periods; pre-implementation (Pre; May 2011 - May 2013) and post-implementation (Post; May 2015 - May 2017). Patients were excluded if not admitted or were discharged/deceased before blood culture results. The primary outcome of this study was to compare time to optimal therapy (TOT). Secondary outcomes included hospital mortality, length of stay (LOS), and TOT comparing clinical pharmacy staffing models. Multivariable logistic regression models were used to identify independent predictors. Adjusted ORs (aOR) and their 95% CIs were reported. Results A total of 104 patients with VRE BSIs were included in the study; 50 and 54 in the pre- and post-implementation periods, respectively. There were no differences in baseline characteristics between the groups. TOT was significantly shorter in the post vs. pre group (29 hrs ± 36 vs. 67 hrs ± 124, p=0.03). There was significantly lower hospital mortality when comparing the pre- and post-implementation periods (32% vs. 11%, p< 0.01). After adjusting for age, sex, severity of illness, treatment/dose, the post implementation period was independently associated with reduced hospital mortality (aOR 0.21, CI 0.61–0.73, p=0.01). There were no significant differences in LOS or clinical pharmacy staffing models on TOT. Baseline Characteristics Primary and secondary outcomes data Conclusion The implementation of the Verigene® BC-GP with VigiLanz® substantially decreased TOT for VRE BSIs and was associated with reduced hospital mortality. This study highlights the positive impact of RDTs on shorter TOT and associated clinical outcomes. Disclosures All Authors: No reported disclosures

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Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

BMC Infectious Diseases ◽

10.1186/s12879-021-06391-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sandra Chamat-Hedemand ◽

Niels Eske Bruun ◽

Lauge Østergaard ◽

Magnus Arpi ◽

Emil Fosbøl ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

High Risk ◽

Blood Culture ◽

Positive Blood Culture ◽

Bloodstream Infections ◽

Low Risk ◽

Moderate Risk ◽

Streptococcal Species ◽

Very High

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

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Utility of Red Cell Distribution Width (RDW) In Diagnosis and Prognosis of Early-Onset Neonatal Sepsis in Term Neonates

SciMedicine Journal ◽

10.28991/scimedj-2021-0303-7 ◽

2021 ◽

Vol 3 (3) ◽

pp. 257-264

Author(s):

Sandeep Golhar ◽

Abhishek Madhura ◽

Urmila Chauhan ◽

Abinash Nayak

Keyword(s):

Blood Culture ◽

Hospital Mortality ◽

Positive Blood Culture ◽

Neonatal Sepsis ◽

Early Onset ◽

Red Cell ◽

Cell Distribution ◽

Distribution Width ◽

Term Neonates ◽

Diagnosis And Prognosis

Objective: To assess the increased Red Cell Distribution Width (RDW) in diagnosis and prognosis of early-onset neonatal sepsis in term neonates. Methods: In a prospective, observational study, we enrolled term neonates ( 37 weeks of gestation) clinically suspected for Early-Onset Neonatal Sepsis (EONS) (within 7 days of birth). A cut-off of 18% and above was taken to consider RDW as abnormal or increased. The primary outcome was to assess the relation of increased RDW with in-hospital mortality. The secondary outcome was to determine the diagnostic yield of increased RDW in culture-proven sepsis. Results: In 166 neonates, 60% were males. Increased RDW was seen in 42.42% of neonates and 15.75% of neonates had positive blood culture. Compared to normal RDW, in-hospital mortality was significantly higher in neonates with increased mortality (27.14% vs. 10.52%, respectively; p=0.006). Also, abnormal RDW was seen in 46.15% of neonates with positive blood culture compared to 35.25% of neonates with negative blood culture (p<0.0001). Thus, elevated RDW had a sensitivity of 44.4% and specificity of 57.97% in the diagnosis of EONS. Conclusion: Increased RDW can be a diagnostic as well as a prognostic marker in neonates with EONS. Such observation indicates it may serve as a simple and easily available marker for EONS in resource-limited settings. However, these findings need to be confirmed in a larger sample. Doi: 10.28991/SciMedJ-2021-0303-7 Full Text: PDF

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[18F]FDG hypermetabolisms of the spleen and/or bone marrow: indirect signs of bacteremia

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab111.073 ◽

2021 ◽

Vol 22 (Supplement_3) ◽

Author(s):

R Zanca ◽

F Bartoli ◽

E Lazzeri ◽

M Sollini ◽

RHJA Slart ◽

...

Keyword(s):

Bone Marrow ◽

Blood Culture ◽

Positive Blood Culture ◽

Test Procedure ◽

Lumbar Vertebrae ◽

Final Diagnosis ◽

Negative Blood Culture ◽

Suspected Infection ◽

Significant Difference ◽

18F Fdg

Abstract Funding Acknowledgements Type of funding sources: None. Aim Recently hypermetabolisms of the spleen and/or bone marrow has been proposed as an indirect sign of infective endocarditis (IE), useful to reinforce the suspicion of IE in the absence of any other infectious, inflammatory, or malignant disease. The purpose of this study is to determine whether hypermetabolisms of the spleen and/or bone marrow are indirect signs of bacteremia rather than of IE, specifically. Materials and Method In this work we retrospectively evaluated a series 240 patients who performed between January 2015 to December 2020 [18F]FDG PET/CT (Discovery 710 GE) for suspected infection. In particular, 80 pts had infections from different origin and a positive blood culture (PBC), 80 pts presented localized infection, but negative blood culture (IDBCN) and 80 pts were classified as definite IE (IED) according to the 2015 ESCcriteria. [18F]FDG SUVmax SUVmean in bone marrow, spleen and liver were measured drawind a 14 cm3 regions of interest (ROIs) positioned close to the centers of the spleen and of the right liver lobe, but excluding abscess and/or ischemic lesions., as previously described (Caroline Boursier et al. ; Jordy P.Pijl et al.). BM SUVmax and SUVmean was obtained from ROIs placed on the bodies of each of the five lumbar vertebrae, excluding any damaged vertebra. BM to liver SUV ratios (BLR) and spleen to liver SUV ratios (SLR) were calculated. Kruskal-Wallis tests and the Dunn’s test procedure for multiple comparison were performed using JMP Statistical Discoverytm. Results No significant difference among the three groups of SUVmax/mean or in SLR were found. Nevertheless, by grouping patients for the presence of positive blood culture (142 pts) or negative blood culture (98 pts), irrespectively from the final diagnosis a significant associations of SLR was found (p = 0.0070). No significant associations were found with BLR. Conclusions Based on our data SLR in seems to represent an indirect signs of bacteremia, rather than IE.

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301. Penicillin Versus Cefazolin or Anti-staphylococcal Penicillins for Penicillin-Susceptible Staphylococcus aureus Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.344 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S149-S149

Author(s):

Mohammed Aldhaeefi ◽

Jeffrey Pearson ◽

Sanjat Kanjilal ◽

Brandon Dionne

Keyword(s):

Staphylococcus Aureus ◽

Blood Culture ◽

Positive Blood Culture ◽

Medical Center ◽

Academic Medical Center ◽

Similar Distribution ◽

Clinical Failure ◽

Staphylococcus Aureus Bacteremia ◽

Definitive Therapy ◽

Significant Difference

Abstract Background Staphylococcus aureus bacteremia is a significant cause of mortality. Penicillin (PCN) may have a role in the treatment of penicillin-susceptible Staphylococcus aureus (PSSA) bacteremia as it has a narrower spectrum of activity than cefazolin and is better tolerated than antistaphylococcal penicillins (ASPs). The aim of this study is to evaluate the safety and effectiveness of PCN versus cefazolin or ASPs in the treatment of PSSA bacteremia. Methods This is a single-center, retrospective study at a tertiary academic medical center. All patients with a PSSA blood culture from January 1, 2012 to September 1, 2019 were screened. Patients were excluded if they were treated with a definitive antibiotic (defined as antimicrobial therapy received 72 hours after positive blood culture) other than the study comparators, or if they received combination antibiotic therapy >72 hours from the initial positive blood culture result. The primary outcome was 60-day clinical failure, which was a composite endpoint of change in antibiotic after 72 hours of definitive therapy, recurrence of PSSA bacteremia, infection-related readmission, or all-cause mortality. Results Of 277 patients with PSSA bacteremia, 101 patients were included in the study; 62 (61%) were male and 11 (11%) had a β-lactam allergy. At baseline, 40 patients (40%) had hardware, 25 (25%) had an intravenous line, 6 (6%) were on dialysis, and 4 (4%) had active IV drug use, with similar distribution across antibiotic groups. Penicillin was the most common antibiotic used (Table 1). There was a significant difference among groups with respect to the 60-day clinical failure (log-rank p=0.019). In terms of unadjusted 60-day clinical failure, penicillin had similar outcomes to cefazolin (95% CI -0.29 to 0.104, p=0.376), however, it had statistically significant better outcomes in comparison to the ASPs, nafcillin or oxacillin (95% CI 0.023 to 0.482, p=0.031) (Table 1). Table 1. 60-day outcomes of PSSA bacteremia Conclusion Penicillin is effective and safe in the treatment of PSSA bacteremia and may be preferable to antistaphylococcal penicillins Disclosures All Authors: No reported disclosures

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Optimization of antimicrobial therapy in vancomycin-resistant enterococcal bacteraemia using a rapid detection Gram-positive blood culture assay

Journal of Hospital Infection ◽

10.1016/j.jhin.2017.12.012 ◽

2018 ◽

Vol 99 (2) ◽

pp. 153-157 ◽

Cited By ~ 1

Author(s):

R. Nakagawa ◽

R. Jain ◽

A.B. Bryan ◽

J.D. Chan

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Antimicrobial Therapy ◽

Rapid Detection ◽

Gram Positive ◽

Vancomycin Resistant

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Abstract WP380: Thyrotoxicosis is Associated With Worse In-Hospital Mortality in Patients With Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp380 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Sakiru O Isa ◽

Olajide Buhari ◽

Hameem Changezi

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Length Of Hospital Stay ◽

The Body ◽

Significant Difference ◽

History Of ◽

Group 3 ◽

Group 2 ◽

Time Of Presentation ◽

Group 1

Introduction: Hyperthyroidism increases the basal metabolic rate and affects most systems in the body. Patients with hyperthyroidism have been shown to have a higher incidence of ischemic stroke. There is a paucity of information regarding its effects on the short-term outcomes of patients admitted with ischemic stroke. Hypothesis: Hyperthyroidism is associated with worse in-hospital outcomes in patients admitted for ischemic stroke. Methods: We queried the National Inpatient Sample to identify adult patients(aged 18 and above) admitted for ischemic stroke between January 2011 and December 2014. We compared those with a history of hyperthyroidism (group 1) and thyrotoxicosis on admission (group 2) with the rest of the patients (group 3). The main outcome was in-hospital mortality. Secondary outcomes included the length of hospital stay and cost of hospitalization. We used the logistic regression model and adjusted for baseline characteristics and co-morbidities. Results: There were 643,786 patients in the study, 0.44% had a history of hyperthyroidism, and 0.01% had thyrotoxicosis at the time of presentation. The odd of mortality in group 1 compared to group 3 was 0.89, 95% CI 0.75-1.05, p=0.16 while in group 2 compared to group 3, it was 2.42, 95% CI 1.29-4.52, p<0.006. The mean length of stay was also longer in group 2 with a mean difference of 8.06, 95% CI 4.74 - 11.39, p<0.0001. Conclusion: From the study, there was no significant difference in in-hospital mortality between patients with previously diagnosed hyperthyroidism and those without diagnosed hyperthyroidism. Patients who had thyrotoxicosis on admission, on the other hand, had worse outcomes compared to patients without thyrotoxicosis.

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