643. Evaluation of Rapid Blood Pathogen Identification Along with Antimicrobial Stewardship at an Academic Teaching Institution

Abstract Background Bloodstream infections are a major cause of morbidity and mortality in hospitalized patients. Prompt initiation of effective antimicrobials are essential to optimize patient outcomes. New diagnostic technologies rapidly identifying bacteria, viruses, fungi, and parasites in infections of various body sites. There is a paucity of literature determining if stewardship programs run by one trained pharmacist with rapid diagnostics decreases time to optimal antimicrobial therapy. Methods This was a retrospective chart review of positive bloodstream infections identified via rapid diagnostic technologies. The EHR of admitted adult patients with positive BSI identified by BioFire FilmArray Blood Culture Identification (BCID) Panel™ or Accelerate PhenoTest Blood Culture kit™2 between January 2018 – July 2019 were evaluated and pertinent data was collected. Results Rapid diagnostic technologies identified 108 bloodstream infections due to gram positive, 56 due to gram negative, and 6 due to Candida organisms. Mean time to optimal antimicrobial therapy was significantly lower when pharmacist recommendation was accepted versus when primary care team consulted ID for recommendation or did not accept pharmacist recommendation. Mean time to optimal therapy was 14.7, 34.3, and 271.3 hours (p< 0.0001) respectively. Median total cost of visit per patient, calculated using the average wholesale price of antibiotics multiplied by the number of doses received, was significantly lower when pharmacist recommendations were accepted (&86.40, &147.95, and &239.41, respectively). Baseline characteristics Microbiological isolates Primary Outcome: Time to Optimal Therapy Conclusion The establishment of a pharmacist run antimicrobial stewardship program in conjunction with rapid diagnostic tools for identifying bacteremia led to a decrease in time to optimal antimicrobial therapy and cost savings. Introduction of similar services at community hospitals with limited ASP staffing is justified. Larger studies to further investigate whether ASP partnered with rapid diagnostics have an impact on patient-related outcomes such as mortality and length of stay is warrented. Secondary outcomes Missed cost savings Disclosures All Authors: No reported disclosures

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Impact of a Rapid Blood Culture Diagnostic Panel on Time to Optimal Antimicrobial Therapy at a Veterans Affairs Medical Center

Journal of Pharmacy Practice ◽

10.1177/08971900211000686 ◽

2021 ◽

pp. 089719002110006

Author(s):

Jordan M. Chiasson ◽

Winter J. Smith ◽

Tomasz Z. Jodlowski ◽

Marcus A. Kouma ◽

James B. Cutrell

Keyword(s):

Blood Culture ◽

Antimicrobial Stewardship ◽

Medical Center ◽

Diagnostic Testing ◽

Bloodstream Infections ◽

Rapid Diagnostics ◽

Post Intervention ◽

Optimal Therapy ◽

Stewardship Program ◽

Days Of Therapy

Purpose: Utilization of rapid diagnostic testing alongside intensive antimicrobial stewardship interventions improves patient outcomes. We sought to determine the clinical impact of a rapid blood culture identification (BCID) panel in an established Antimicrobial Stewardship Program (ASP) with limited personnel resources. Methods: A single center retrospective pre- and post-intervention cohort study was performed following the implementation of a BCID panel on patients admitted with at least 1 positive blood culture during the study period. The primary outcome was time to optimal therapy from blood culture collection. Secondary outcomes included days of therapy (DOT), length of stay, and 30-day mortality and readmission rates. Results: 277 patients were screened with 180 patients included, with 82 patients in the pre-BCID and 98 in the post-BCID arms. Median time to optimal therapy was 73.8 hours (IQR; 1.1-79.6) in the pre-BCID arm and 34.7 hours (IQR; 10.9-71.6) in the post-BCID arm (p ≤ 0.001). Median DOT for vancomycin was 4 and 3 days (p ≤ 0.001), and for piperacillin-tazobactam was 3.5 and 2 days (p ≤ 0.007), for the pre-BCID and post-BCID arms, respectively. Median length of hospitalization was decreased from 11 to 9 days (p = 0.031). No significant change in 30-day readmission rate was noted, with a trend toward lower mortality (12% vs 5%; p = 0.086). Conclusion: Introduction of BCID into the daily workflow resulted in a significant reduction in time to optimal therapy for bloodstream infections and DOT for select broad-spectrum antibiotics, highlighting the potential benefits of rapid diagnostics even in settings with limited personnel resources.

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313. Using a Clinical Decision Prediction Tool to Improve Empirical Antimicrobial Therapy in Ceftriaxone-Resistant Enterobacterales Bloodstream Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.356 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S153-S153

Author(s):

Elizabeth McDougal ◽

Julie Ann Justo ◽

Joseph Kohn ◽

P B Bookstaver ◽

Hana R Winders ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Real Time ◽

Antimicrobial Stewardship ◽

Antimicrobial Susceptibility ◽

Antimicrobial Therapy ◽

Bloodstream Infections ◽

Prediction Score ◽

Resistant Bacteria ◽

The Impact ◽

Mean Time

Abstract Background There are several clinical tools for prediction of antimicrobial resistance. However, their utility in management of bloodstream infections (BSI) due to resistant bacteria remains unclear. This quasi-experimental cohort examined the impact of utilization of the extended-spectrum beta-lactamase (ESBL) prediction score on time to initiation of appropriate antimicrobial therapy (AAT) in BSI due to ceftriaxone-resistant (CRO-R) Enterobacterales. Methods Adults with first episodes of monomicrobial BSI due to CRO-R Enterobacterales at Prisma Health-Midlands Hospitals in South Carolina from January 2010 to December 2017 were included. Antimicrobial stewardship intervention was implemented in January 2014 consisting of real-time alerts for positive blood cultures and rapid diagnostics for identification of bloodstream isolates. The ESBL prediction score was used to stratify risk of resistance prior to conventional antimicrobial susceptibility results. Student’s t-test was used to compare mean time to AAT before and after intervention. Results Among 92 patients with BSI due to CRO-R Enterobacterales, median age was 66 years, 52 (57%) were men, 68 (74%) had community-onset BSI, and 52 (57%) had urinary source of infection. Escherichia coli 52 (57%) and Klebsiella species 27 (29%) were the most common bloodstream isolates and the majority 63 (68%) produced ESBLs. There were no significant differences in demographics or clinical characteristics of patients before (n=45) and after (n=47) antimicrobial stewardship intervention. Mean time to AAT was 3.2 days prior and 1.7 days after utilization of ESBL prediction score (p=0.021). Results were consistent among ESBL-producing Enterobacterales (time to AAT 2.8 before and 1.8 days after intervention, p=0.025). Conclusion Utilization of the ESBL prediction score as part of a real-time antimicrobial stewardship intervention significantly reduced time to AAT in BSI due to CRO-R and ESBL-producing Enterobacterales. The ESBL prediction score represents a viable tool to improve antimicrobial management in clinical settings that lack access to multiplex PCRs for detection of antimicrobial resistance genes and novel methods for rapid phenotypic antimicrobial susceptibility testing. Disclosures Julie Ann Justo, PharmD, MS, BCPS-AQ ID, bioMerieux (Speaker’s Bureau)TRC Healthcare (Speaker’s Bureau)

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1998. Impact of Rapid Blood Culture Identification with Real-Time Antimicrobial Stewardship (ASP) in Patients with Staphylococcus aureus (S. aureus) and Enterococcus spp. Bacteremia at a Large Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1678 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S670-S670

Author(s):

Hannah Ryan Russo ◽

Kady Phe ◽

Mayar Al Mohajer ◽

Jessica Hirase

Keyword(s):

Blood Culture ◽

Real Time ◽

Antimicrobial Stewardship ◽

Antimicrobial Therapy ◽

Intervention Group ◽

Active Therapy ◽

Post Intervention ◽

Optimal Therapy ◽

Enterococcus Spp ◽

Culture Identification

Abstract Background The initiation of appropriate antimicrobial therapy is dependent on timely identification of the pathogen. FilmArray Blood Culture Identification Panel (BCID) is a rapid, multiplex polymerase chain reaction (PCR) panel that identifies 24 pathogens and 3 antibiotic resistance genes associated with bloodstream infections within 1 hour of growth. The purpose of this study was to compare the clinical impact of rapid BCID testing vs. standard blood culture processing, both coupled with real-time ASP, in patients with S. aureus and Enterococcus spp. bacteremia. Methods This was a single-center, retrospective chart review conducted as a pre-post intervention quasi-experimental study. The pre-intervention group included adult patients with S.aureus and Enterococcus spp. bacteremia identified by standard blood culture processing (PRE) and the post-intervention group included those identified by rapid BCID testing (POST). The primary endpoint was time in hours from positive Gram stain to initiation of optimal antimicrobial therapy [defined as vancomycin (VAN), linezolid (LZD), daptomycin (DAP), or ceftaroline for methicillin-resistant S. aureus (MRSA); nafcillin or cefazolin for methicillin-susceptible S. aureus (MSSA); DAP or LZD for VAN-resistant Enterococcus (VRE); VAN or ampicillin (if susceptible) for VAN-susceptible Enterococcus (VSE)]. Secondary endpoints included time to active therapy (defined as an antimicrobial to which the organism was susceptible), time to identification of pathogen, length of hospital stay (LOS) after positive culture, and 30-day mortality. Results 132 patients were included. Mean time to optimal therapy decreased from 21.4 hours PRE to 10.7 hours POST (P = 0.048). Time to optimal therapy was shorter POST for MSSA [59.2 hours PRE vs. 25.8 hours POST (P < 0.001)] and VRE bacteremia [24.6 hours PRE vs. 5.6 hours POST (P = 0.005)]. Time to identification of pathogen decreased from 75.6 hours PRE to 2.7 hours POST (P < 0.001). Groups did not differ in time to active therapy, LOS, nor 30-day mortality. Conclusion Antimicrobial Stewardship coupled with rapid BCID testing significantly decreased time to pathogen identification as well as time to optimal therapy in patients with S. aureus and Enterococcus spp. bacteremia, most notably for MSSA and VRE. Disclosures All authors: No reported disclosures.

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115. Influence of Antimicrobial Stewardship and Molecular Rapid Diagnostic Test on Antimicrobial Prescribing for Extended-spectrum Beta-lactamase and Carbapenemase-producing Bacteria in Bloodstream Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.160 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S71-S72

Author(s):

Ashlan Kunz Coyne ◽

Anthony Casapao ◽

Carmen Isache ◽

James Morales ◽

Yvette McCarter ◽

...

Keyword(s):

Blood Culture ◽

Antimicrobial Stewardship ◽

Antimicrobial Therapy ◽

Bloodstream Infections ◽

Beta Lactamase ◽

Extended Spectrum Beta Lactamase ◽

E Coli ◽

Extended Spectrum ◽

Kaplan Meier ◽

Baseline Characteristics

Abstract Background Molecular rapid diagnostic tests (mRDT) may help expedite the time to optimal antimicrobial therapy (TTOT) for extended-spectrum beta-lactamase (ESBL)- and carbapenemase-producing bacteria in bloodstream infections (BSI). The greatest impact of mRDT appears to occur when combined with antimicrobial stewardship program (ASP) intervention. The purpose of this study was to evaluate if mRDT + ASP influences the TTOT for patients with ESBL- and carbapenemase-producing E. coli and K. pneumoniae in BSI compared to conventional microbiological methods with ASP (CONV + ASP). Methods Multicenter, retrospective, cohort study evaluating five years of patients that had a positive E. coli or K. pneumoniae blood culture determined to be ESBL- or carbapenemase-producing by mRDT and/or CONV. Patients were excluded if they had polymicrobial BSI, transferred–in with previously identified positive blood cultures, were immunosuppressed, or died before culture results. Primary outcome was TTOT defined as time from blood culture draw to start of carbapenem therapy for ESBL-producing BSI and ceftazidime-avibactam, meropenem-vaborbactam, or at least one drug active in-vitro with the most-narrow spectrum for carbapenemase-producing BSI. Secondary outcomes were time to microbial clearance (TTMC) defined as the time from index blood culture draw to the time of first negative blood culture or hospital discharge, all-cause hospital mortality, 30-, 60- and 90-day readmission rates, and Clostridioides difficile rates. Results A total of 378 patients were included for analysis. Baseline characteristics were balanced between mRDT + ASP (n=164) and CONV + ASP (n=214). Infectious diseases consults were significantly greater for CONV + ASP compared to mRDT + ASP (82.2% vs 34.8%; p< 0.001). The mRDT + ASP demonstrated a statistically significant decrease in TTOT (20.5 hrs [(IQR 17.0–42.2 hrs)] vs 50.1 hrs [(IQR 27.6–77.9 hrs)]; p< 0.001) and TTMC (71.9 hrs [(IQR 54.1–108.5 hrs)] vs 91.2 hrs [(IQR 64.6–134.3 hrs)]; p=0.007). Other secondary endpoints were similar between groups. Table 1. Comparison of baseline characteristics for the mRDT+ASP and CONV+ASP groups Graph 1. Kaplan Meier time to optimal antimicrobial therapy Graph 2. Kaplan Meier time to microbial clearance Conclusion Our study supports the additional benefit of mRDT to ASP on shortening the TTOT and TTMC in patients with ESBL- or carbapenemase-producing E. coli and K. pneumoniae in BSI compared to CONV + ASP. Disclosures All Authors: No reported disclosures

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49. Impact of a Rapid Genotypic Platform for Gram-negative Bloodstream Infections, Paired with an Antimicrobial Stewardship Intervention, on Time to Optimal Antimicrobial Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.251 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S145-S145

Author(s):

Madison Donnelly ◽

Jennifer Walls ◽

Katlyn Wood ◽

Aiman Bandali

Keyword(s):

Length Of Stay ◽

Antimicrobial Stewardship ◽

Antimicrobial Therapy ◽

Intervention Group ◽

Bloodstream Infections ◽

Post Intervention ◽

Gram Negative ◽

E Coli ◽

Optimal Therapy ◽

The Impact

Abstract Background Gram-negative bacteremia is associated with significant morbidity and mortality. Development of an algorithm for antimicrobial selection, using institution-specific antibiogram data and rapid diagnostics (RDT), achieves timely and appropriate antimicrobial therapy. The objective of this study is to assess the impact of a pharmacy-driven antimicrobial stewardship initiative in conjunction with ePlex® BCID on time to optimal antimicrobial therapy for patients with gram-negative bloodstream infections. Methods This retrospective, observational, single-center study included adult patients with a documented gram-negative bloodstream infection in whom the ePlex® BCID was employed. A pharmacist-driven antimicrobial stewardship intervention was initiated on December 1, 2020; pre-intervention (December 2019 – March 2020) was compared to the post-intervention (December 2020 – February 2020) period. The following organisms were included: Citrobacter spp., Escherichia coli, Klebsiella aerogenes/pneumoniae/oxytoca, Proteus spp, Enterobacter spp., Pseudomonas aeruginosa, and Acinetobacter baumannii. Polymicrobial bloodstream infections or those who had an ePlex® panel performed prior to admission were excluded. The following clinical outcomes were assessed: time to optimal antimicrobial therapy, length of stay (LOS), and inpatient-30-day mortality. Results One hundred and sixty-three met criteria for inclusion; 98 patients in the pre-intervention group and 65 patients in the post-intervention group. The mean Pitt Bacteremia Score was 1 in both groups (p=0.741). The most common organism identified by ePlex® BCID was E. coli (65.3% vs 70.8%; p=0.676). Eight E. Coli isolates were CTX-M positive; no other gene targets were detected. The most common suspected source of bacteremia was genitourinary (72.5% vs 72.3%; p=1.0). Time to optimal therapy was reduced by 29 hours [37 (31 – 55) vs. 8 (4 – 28); p=0.048). Length of stay and mortality was similar between groups. Conclusion Implementation of a rapid blood culture identification panel along with an antimicrobial stewardship intervention significantly reduced time to optimal therapy. Further studies are warranted to confirm these results. Disclosures All Authors: No reported disclosures

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Impact of a Multiplex PCR Assay for Bloodstream Infections With and Without Antimicrobial Stewardship Intervention at a Cancer Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy258 ◽

2018 ◽

Vol 5 (10) ◽

Cited By ~ 10

Author(s):

Brian A Buss ◽

Timothy J Baures ◽

Minkyoung Yoo ◽

Kimberly E Hanson ◽

Donald P Alexander ◽

...

Keyword(s):

Blood Culture ◽

Multiplex Pcr ◽

Antimicrobial Stewardship ◽

Antimicrobial Therapy ◽

Bloodstream Infections ◽

Pcr Assay ◽

Cancer Hospital ◽

Multiplex Pcr Assay ◽

Culture Identification ◽

Reduced Time

Abstract Implementation of Biofire FilmArray Blood Culture Identification Multiplex PCR panel (BCID) at a cancer hospital was associated with reduced time to appropriate antimicrobial therapy. Additional reductions were not observed when BCID was coupled with antimicrobial stewardship intervention.

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Comparing the clinical utility of rapid diagnostics for the treatment of Bloodstream Infections using Desirability of Outcome Ranking approach for the Management of Antibiotic Therapy (DOOR-MAT)

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00441-21 ◽

2021 ◽

Author(s):

Kimberly C. Claeys ◽

Teri L. Hopkins ◽

Kathryn Schlaffer ◽

Stephanie Hitchcock ◽

Yunyun Jiang ◽

...

Keyword(s):

Blood Culture ◽

Antimicrobial Therapy ◽

Clinical Utility ◽

Credit Scoring ◽

Bloodstream Infections ◽

Rapid Diagnostic Tests ◽

Research Use ◽

Rapid Diagnostics ◽

University Of Maryland ◽

The Mean

Background: Decisions regarding which rapid diagnostic tests (RDT) for bloodstream infections to implement remains challenging given the diversity of organisms detected by different platforms. We used the Desirability of Outcome Ranking Management of Antimicrobial Therapy (DOOR-MAT) as a framework to compare two RDT platforms on potential desirability of antimicrobial therapy decisions. Methods: An observational study was performed at University of Maryland Medical System comparing Verigene Blood Culture (BC) to GenMark Dx ePlex Blood Culture ID (BCID) (Research Use Only) panels on blood cultures from adult patients. Positive percent agreement (PPA) between each RDT platform and Vitek MS was calculated for comparison of on-panel targets. Theoretical antimicrobial decisions were made based on RDT results, taking into consideration patient parameters, antimicrobial stewardship practices, and local infectious diseases epidemiology. DOOR-MAT with a partial credit scoring system was applied to these decisions and mean scores compared across platforms using paired t-test. Results: The study consisted of 160 unique patients. The Verigene BC PPA was 98.6% (95% CI 95.1, 99.8) and ePlex BCID PPA was 98% (95% CI 94.3, 99.6). Among the 31 organisms not on the Verigene BC panels, 61% were identified by the ePlex BCID Panels. The mean (standard deviation [SD]) DOOR-MAT score for Verigene BC was 86.8 (SD ± 28.5) versus ePlex BCID was 91.9 (SD ± 23.1), P = 0.01. Conclusion: Both RDT platforms had high PPA for on-panel targets. The ePlex BCID was able to identify more organisms than Verigene, resulting in higher mean DOOR-MAT scores.

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2001. Assessment of Real-world Effectiveness of a Rapid Blood Culture Diagnostic Panel at a Veterans Affairs Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1681 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S671-S671

Author(s):

Jordan Chiasson ◽

James B Cutrell ◽

Jodlowski Tomasz ◽

Winter Smith ◽

...

Keyword(s):

Length Of Stay ◽

Blood Culture ◽

Negative Impact ◽

Medical Center ◽

Bloodstream Infections ◽

Rapid Diagnostics ◽

Readmission Rates ◽

Optimal Therapy ◽

Stewardship Program ◽

Days Of Therapy

Abstract Background Rapid blood culture diagnostics can improve patient outcomes, particularly when paired with robust interventions such as 24/7 stewardship coverage. We sought to determine the clinical impact of a rapid blood culture identification (BCID) panel (BioFire® FilmArray Multiplex PCR) in an established antimicrobial stewardship program (ASP). In addition to clinician education, BCID results were reviewed by the ASP team during weekday business hours, for an average of 2 hours daily based on availability. Methods Data on demographics, blood cultures, antimicrobial use, length of stay and mortality were collected on inpatients at the VA North Texas Health Care System with at least one positive blood culture for bacterial or yeast isolates from March 2017 to June 2017 (pre-BCID) and from March 2018 to June 2018 (post-BCID). The primary outcome was a composite of time to optimal therapy from blood culture collection, defined as escalation, de-escalation, discontinuation, or optimization of antimicrobials retrospectively adjudicated based on final culture results. Secondary outcomes included time to effective therapy, total days of therapy (DOT), length of stay, and 30-day mortality and readmission rates. Results 195 patients were screened with 130 patients included in the study. No significant differences in baseline characteristics were observed between groups (Table 1). Sixty-one patients were included in the pre-BCID arm and 69 in the post-BCID arm. Median time to optimal therapy was 82.9 hours (IQR; 12.8–99.8) in the pre-BCID arm and 33.9 hours (IQR; 11.2–64.8) in the post-BCID arm (P = 0.005) (Table 2). No significant change in 30-day mortality or 30-day readmission rates was noted. Vancomycin DOT was 4 days (IQR; 2–5) and 3 days (IQR; 1–4) (P = 0.024), and piperacillin–tazobactam DOT was 4 (IQR; 0–5) and 2 (IQR; 0–4) (P = 0.043), in the pre-BCID and post-BCID groups, respectively (Figure 1). Conclusion Introduction of BCID into the daily workflow of our ASP resulted in a significant reduction in time to optimal therapy for bloodstream infections. DOT for select broad-spectrum antibiotics were also significantly reduced. This study highlights the potential benefit of rapid diagnostics without negative impact to patient care even in settings without resources for 24/7 ASP review. Disclosures All authors: No reported disclosures.

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Cumulative Effect of an Antimicrobial Stewardship and Rapid Diagnostic Testing Bundle on Early Streamlining of Antimicrobial Therapy in Gram-Negative Bloodstream Infections

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00189-17 ◽

2017 ◽

Vol 61 (9) ◽

Cited By ~ 31

Author(s):

P. B. Bookstaver ◽

E. B. Nimmich ◽

T. J. Smith ◽

J. A. Justo ◽

J. Kohn ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Antimicrobial Therapy ◽

Phase 1 ◽

Bloodstream Infections ◽

Antimicrobial Stewardship Program ◽

Phase 2 ◽

Beta Lactams ◽

Gram Negative ◽

Stewardship Program ◽

Tof Ms

ABSTRACT The use of rapid diagnostic tests (RDTs) enhances antimicrobial stewardship program (ASP) interventions in optimization of antimicrobial therapy. This quasi-experimental cohort study evaluated the combined impact of an ASP/RDT bundle on the appropriateness of empirical antimicrobial therapy (EAT) and time to de-escalation of broad-spectrum antimicrobial agents (BSAA) in Gram-negative bloodstream infections (GNBSI). The ASP/RDT bundle consisted of system-wide GNBSI treatment guidelines, prospective stewardship monitoring, and sequential introduction of two RDTs, matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) and the FilmArray blood culture identification (BCID) panel. The preintervention period was January 2010 through December 2013, and the postintervention period followed from January 2014 through June 2015. The postintervention period was conducted in two phases; phase 1 followed the introduction of MALDI-TOF MS, and phase 2 followed the introduction of the FilmArray BCID panel. The interventions resulted in significantly improved appropriateness of EAT (95% versus 91%; P = 0.02). Significant reductions in median time to de-escalation from combination antimicrobial therapy (2.8 versus 1.5 days), antipseudomonal beta-lactams (4.0 versus 2.5 days), and carbapenems (4.0 versus 2.5 days) were observed in the postintervention compared to the preintervention period (P < 0.001 for all). The reduction in median time to de-escalation from combination therapy (1.0 versus 2.0 days; P = 0.03) and antipseudomonal beta-lactams (2.2 versus 2.7 days; P = 0.04) was further augmented during phase 2 compared to phase 1 of the postintervention period. Implementation of an antimicrobial stewardship program and RDT intervention bundle in a multihospital health care system is associated with improved appropriateness of EAT for GNBSI and decreased utilization of BSAA through early de-escalation.

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.093 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S47-S47

Author(s):

Bryant M Froberg ◽

Nicholas Torney

Keyword(s):

Blood Culture ◽

Hospital Mortality ◽

Positive Blood Culture ◽

Antimicrobial Therapy ◽

Length Of Hospital Stay ◽

Bloodstream Infections ◽

Pharmacist Intervention ◽

Pathogen Identification ◽

Community Hospitals ◽

Significant Difference

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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