scholarly journals 1812. Impact of Rapid Identification of Blood Cultures With Antimicrobial Stewardship at Three Community Hospitals Within a Health System

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S514-S514
Author(s):  
Christy Su ◽  
Jessica Babic ◽  
Amy Schilling ◽  
Audrey Wanger
Keyword(s):  
Health System ◽  
Antimicrobial Stewardship ◽  
Rapid Identification ◽  
Blood Cultures ◽  
Community Hospitals

scholarly journals Parallel Evaluation of the MALDI Sepsityper and Verigene BC-GN Assays for Rapid Identification of Gram-Negative Bacilli from Positive Blood Cultures

2017 ◽  
Vol 55 (9) ◽  
pp. 2708-2718 ◽  
Author(s):  
Miguel A. Arroyo ◽  
Gerald A. Denys
Keyword(s):  
Antimicrobial Stewardship ◽  
Clinical Management ◽  
Rapid Identification ◽  
Blood Cultures ◽  
Clinical Microbiology Laboratory ◽  
Percentage Agreement ◽  
Gram Negative ◽  
Definitive Method ◽  
Parallel Evaluation

ABSTRACT Rapid identification of microorganisms from positive blood cultures has improved clinical management and antimicrobial stewardship. The advent of matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) has reduced the time to identification of cultured isolates and is now often the definitive method used in the clinical microbiology laboratory. The commercial in vitro diagnostic MALDI Sepsityper (Sepsityper) kit has the potential for standardization and clinical routine use for the rapid identification of a broad range of bacteria from positive blood cultures. In this study, we performed a parallel evaluation of the Sepsityper (Bruker Daltonics, Billerica, MA) and the Verigene BC-GN (BC-GN) assays (Nanosphere, Inc., Northfield, IL) for the identification of Gram-negative bacilli. A total of 210 Bactec bottles demonstrating Gram-negative bacilli were prospectively enrolled for this study. Among these, 200 monomicrobial cultures were included in the comparative analysis. For monomicrobial cultures, the BC-GN detected 85% (170/200) compared to that detected by routine culture while the Sepsityper detected 94% (188/200) and 91% (181/200) to the genus and species levels, respectively. Comparable positive percentage agreement and negative percentage agreement were observed between the Sepsityper (96.5% and 98.8%, respectively) and the BC-GN (99.4% and 99.8%, respectively) when only ( n = 170, 85%) organisms targeted by the latter test were included in the analysis. In conclusion, the two methods evaluated in this study showed excellent performance characteristics for the identification of Gram-negative bacilli commonly isolated from blood cultures. The Sepsityper showed a broader identification range capability that may further improve clinical management and antimicrobial stewardship in patients with less frequent Gram-negative bacilli bloodstream infections.

scholarly journals Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time

2016 ◽  
Vol 37 (4) ◽  
pp. 425-432 ◽  
Author(s):  
Ashley M. Lockwood ◽  
Katherine K. Perez ◽  
William L. Musick ◽  
Judy O. Ikwuagwu ◽  
Engie Attia ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Setting Time ◽  
Intervention Group ◽  
Hospital Setting ◽  
Blood Cultures ◽  
Community Hospitals ◽  
Process Measures ◽  
Maldi Tof ◽  
Stewardship Program ◽  
The Impact

OBJECTIVETo assess the impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) mass spectrometry for rapid pathogen identification directly from early-positive blood cultures coupled with an antimicrobial stewardship program (ASP) in two community hospitals. Process measures and outcomes prior and after implementation of MALDI-TOF/ASP were evaluated.DESIGNMulticenter retrospective study.SETTINGTwo community hospitals in a system setting, Houston Methodist (HM) Sugar Land Hospital (235 beds) or HM Willowbrook Hospital (241 beds).PATIENTSPatients ≥18 years of age with culture-proven Gram-negative bacteremia.INTERVENTIONBlood cultures from both hospitals were sent to and processed at our central microbiology laboratory. Clinical pharmacists at respective hospitals were notified of pathogen ID and susceptibility results.RESULTSWe evaluated 572 patients for possible inclusion. After pre-defined exclusion criteria, 151 patients were included in the pre-intervention group and 242 were included in the intervention group. After MALDI-TOF/ASP implementation, the mean identification time after culture positivity was significantly reduced from 32 hours (±16 hours) to 6.5 hours (±5.4 hours) (P<.001); mean time to susceptibility results was significantly reduced from 48 (±22) hours to 23 (±14) hours (P<.001); and time to therapy adjustment was significantly reduced from 75 (±59) hours to 30 (±30) hours (P<.001). Mean hospital costs per patient were $3,411 less in the intervention group compared with the pre-intervention group ($18,645 vs $15,234; P=.04).CONCLUSIONThis study is the first to analyze the impact of MALDI-TOF coupled with an ASP in a community hospital setting. Time to results significantly differed with the use of MALDI-TOF, and time to appropriate therapy was significantly improved with the addition of ASP.Infect. Control Hosp. Epidemiol. 2016;37(4):425–432

scholarly journals 12. Evaluation of Rapid Phenotypic Testing for KPC Carbapenemase Producing klebsiella Pneumoniae Directly from Positive Blood Cultures by Use of “Hot Chocolate” Plates

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S7-S7
Author(s):  
Alexander Lawandi ◽  
Gleice C Leite ◽  
Brigitte Lefebvre ◽  
Jean Longtin ◽  
Todd C Lee
Keyword(s):  
Klebsiella Pneumoniae ◽  
Carbapenem Resistance ◽  
Empiric Therapy ◽  
Turnaround Time ◽  
Rapid Identification ◽  
Blood Cultures ◽  
Minimal Growth ◽  
Maldi Tof ◽  
Considerable Morbidity ◽  
Hot Chocolate

Abstract Background Invasive infections with Carbapenemase Producing Enterobacterales are associated with considerable morbidity and mortality, in part due to the risk of inappropriate empiric therapy. Consequently, the rapid identification of carbapenem resistance is crucial to the management of these infections. We sought to evaluate possible reductions in turnaround time to identification of this resistance in blood cultures growing these organisms by applying rapid phenotypic test kits to growth from “hot chocolate” plates. Methods 30 blood cultures, spiked with carbapenem resistant Klebsiella pneumoniae isolates or susceptible controls, were inoculated onto chocolate agars that had pre-warmed at 37°C. These plates were incubated at 37ºC for 3.5 hours. The resulting minimal growth was then identified using MALDI-TOF and underwent rapid phenotypic testing using three commercially available products (β-lacta and β-carba, from Bio-Rad, Marnes-la-Coquette, France, and Carba-NP, from bioMérieux, Durham, NC). The time to identification of carbapenem resistance using this method was then compared to that of the conventional laboratory workup. Results The identification was 100% accurate to the species level using MALDI-TOF paired to the 3.5 hour growth on the “hot choocolate” plates. The β-lacta kit identified resistance to 3rd generation cephalosporins for all ESBL and carbapenemase producing Klebsiella pneumoniae isolates, while the β-carba and Carba-NP kits identified carbapenem resistance only in the carbapenemase producers. The sensitivity of all assays was 100% (95% CI 0.87–1.0) and the specificity of carbapenemase detection was 100% (97.5% one-sided CI 0.4–1.0). The corresponding sensitivities and specificities of direct disc diffusion for ertapenem resistance detection were 88.5% (95% CI 0.70–0.98) and 100% (95%CI 0.40–1.0) respectively. The turnaround time for the rapid kits coupled to the “hot chocolate” plates was 4.25 to 5.1 hours as compared to 16 hours for the conventional workup. Conclusion Rapid phenotypic tests performed after inoculation of “hot chocolate” plates are highly sensitive for the presence of carbapenemase production and can be incorporated into the laboratory workflow for Klebisella pneumoniae with important reductions in turnaround time. Disclosures All Authors: No reported disclosures

scholarly journals Can the Xpert MRSA/SA BC assay be used as an antimicrobial stewardship tool? A prospective assay validation and descriptive impact assessment study in a South African setting

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kessendri Reddy ◽  
Andrew Whitelaw
Keyword(s):  
Bloodstream Infection ◽  
South African ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Rapid Identification ◽  
Western Cape ◽  
Beta Lactams ◽  
Coagulase Negative Staphylococci ◽  
Methicillin Resistant ◽  
Potential Impact

Abstract Background Positive blood cultures showing Gram positive cocci in clusters signifies either Staphylococcus aureus or the less-virulent coagulase-negative staphylococci. Rapid identification and methicillin susceptibility determination with the Xpert MRSA/SA BC assay can improve management of S. aureus bloodstream infection and reduce inappropriate antibiotic use. Methods We prospectively evaluated the Xpert MRSA/SA BC assay in comparison with culture, on samples referred to our laboratory in the Western Cape, South Africa. We interviewed attending clinicians upon culture result availability, to assess antibiotic choices and estimate potential impact of the assay. Results Of the 231 samples included, there was 100% concordance between the Xpert MRSA/SA BC assay and culture (methicillin-resistant S. aureus 15/15, methicillin-susceptible S. aureus 42/42, coagulase-negative staphylococci 170/170). Time to final result could be reduced by approximately 30 h with the assay. Of the 178 patients with adequate antibiotic history, optimisation of antistaphylococcal therapy could have occurred more than 1 day sooner in 68.9% with S. aureus bloodstream infection (31/45, 95% CI 53.2–81.4%). Six of the 11 patients with methicillin-resistant S. aureus bloodstream infection (54.5%) could have received anti-MRSA cover sooner. Fifty-four days of antibiotic therapy could have been spared, equating to 0.3 days (95% CI, 0.2–0.4) saved per patient, driven by broad-spectrum beta-lactams (32 days, in 18.0% of the cohort). Conclusion This assay has potential as an antimicrobial stewardship tool; costing and impact on clinical outcome in patients with S. aureus bloodstream infection should be assessed.

scholarly journals Outcomes of Rapid Identification of Bacteremia in Combination with Antimicrobial Stewardship Intervention

2020 ◽  
Vol 41 (S1) ◽  
pp. s340-s341
Author(s):  
Marilia Bernardes ◽  
Julieth Formosa ◽  
Julia Bini Viotti ◽  
Anthony Febres-Aldana ◽  
Kenneth Ratzan
Keyword(s):  
Antibiotic Therapy ◽  
Antimicrobial Stewardship ◽  
Rapid Identification ◽  
Antibiotic Administration ◽  
Antibiotic Overuse ◽  
Patient Demographics ◽  
Gram Negative Bacteremia ◽  
Polymicrobial Bacteremia ◽  
N 93 ◽  
Organism Identification

Background: Rapid diagnostic tests designed to provide bacterial identification and detection of resistance genes directly from positive blood cultures can significantly reduce the time to definitive results, ensuring appropriate and timely antibiotic administration while simultaneously decreasing antibiotic overuse and development of antimicrobial resistance. However, their impact on in-hospital mortality and length of stay (LOS) is yet to be fully assessed. Methods: We retrospectively reviewed bacteremia cases in patients hospitalized over a 6-month period before (n = 78) and after (n = 93) the implementation of Verigene bacterial nanoparticle testing. Exclusion criteria included age >90 years, bacteremia thought to be a contaminant, polymicrobial bacteremia, or hospice admission. Verigene was performed at a central laboratory from 6 a.m. to 11 p.m. Pharmacists notified physicians of results and assisted with antibiotic modifications. Patient demographics, time to organism identification, time to effective antimicrobial therapy, and other key clinical parameters were compared. The primary outcomes were in-hospital LOS, 14-day mortality, and 30-day mortality. Secondary outcomes included time to effective antibiotic therapy and intensive care unit (ICU) LOS. Results: Organism identification was achieved more quickly (4.9 hours vs 44.5 hours; P < .001) and effective antibiotic therapy was started earlier after Verigene implementation. The mean in-hospital LOS decreased from 13.15 days to 10.02 days (P = .0071) after the Verigene intervention, despite a higher mean Charlson comorbidity index among the cases. Mortality was similar between groups. Conclusions: Rapid identification of gram-positive and gram-negative bacteremia with an antimicrobial stewardship intervention can decrease time to effective antibiotic therapy and total LOS.Funding: NoneDisclosures: None

scholarly journals Antimicrobial Stewardship Standards and Patient Safety: A Case Study in Blood Culture Contamination

2021 ◽  
Vol 1 (S1) ◽  
pp. s36-s36
Author(s):  
Connie Schaefer
Keyword(s):  
Blood Culture ◽  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Standard Method ◽  
Broad Spectrum ◽  
Emergency Departments ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Broad Spectrum Antibiotics ◽  
Contamination Events

Background: Blood culture is a crucial diagnostic tool for healthcare systems, but false-positive results drain clinical resources, imperil patients with an increased length of stay (and associated hospital-acquired infection risk), and undermine global health initiatives when broad-spectrum antibiotics are administered unnecessarily. Considering emerging technologies that mitigate human error factors, we questioned historically acceptable rates of blood culture contamination, which prompted a need to promote and trial these technologies further. In a 3-month trial, 3 emergency departments in a midwestern healthcare system utilized an initial specimen diversion device (ISDD) to draw blood cultures to bring their blood culture contamination rate (4.4% prior to intervention) below the 3% benchmark recommended by the Clinical & Laboratory Standards Institute. Methods: All emergency department nursing staff received operational training on the ISDD for blood culture sample acquisition. From June through August 2019, 1,847 blood cultures were drawn via the ISDD, and 862 were drawn via the standard method. Results: In total, 16 contamination events occurred when utilizing the ISDD (0.9%) and 37 contamination events occurred when utilizing the standard method (4.3%). ISDD utilization resulted in an 80% reduction in blood culture contamination from the rate of 4.4% rate held prior to intervention. Conclusions: A midwestern healthcare system experienced a dramatic reduction in blood culture contamination across 3 emergency departments while pilot testing an ISDD, conserving laboratory and therapeutic resources while minimizing patient exposure to unnecessary risks and procedures. If the results obtained here were sustained and the ISDD utilized for all blood culture draws, nearly 400 contamination events could be avoided annually in this system. Reducing unnecessary antibiotic use in this manner will lower rates of associated adverse events such as acute kidney injury and allergic reaction, which are possible topics for further investigation. The COVID-19 pandemic has recently highlighted both the importance of keeping hospital beds available and the rampant carelessness with which broad-spectrum antibiotics are administered (escalating the threat posed by multidrug-resistant organisms). As more ambitious healthcare benchmarks become attainable, promoting and adhering to higher standards for patient care will be critical to furthering an antimicrobial stewardship agenda and to reducing treatment inequity in the field.Funding: NoDisclosures: None

scholarly journals Antimicrobial Stewardship in Acute-Care Hospitals: A Report of the California Healthcare-Associated Infections Honor Roll

2021 ◽  
Vol 1 (S1) ◽  
pp. s32-s32
Author(s):  
Jane Kriengkauykiat ◽  
Erin Epson ◽  
Erin Garcia ◽  
Kiya Komaiko
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Open Enrollment ◽  
Acute Care Hospitals ◽  
Teaching Hospitals ◽  
Healthcare Associated Infection ◽  
Community Hospitals ◽  
Honor Roll ◽  
Core Elements ◽  
Healthcare Associated

Background: Antimicrobial stewardship has been demonstrated to improve patient outcomes and reduce unwanted consequences, such as antimicrobial resistance and Clostridioides difficile infection. The California Department of Public Health (CDPH) Healthcare-Associated Infection (HAI) Program developed an honor roll to recognize facilities with the goal of promoting antimicrobial stewardship programs and encouraging collaboration and research. Methods: The first open enrollment period in California was from August 1 to September 1, 2020, and was only open to acute-care hospitals (ACHs). Enrollment occurs every 6 months. Applicants completed an application and provided supporting documentation for bronze, silver, or gold designations. The criteria for the bronze designation were at least 1 item from each of CDC’s 7 core elements for ACHs. The criteria for silver were bronze criteria plus 9 HAI program prioritized items (based on published literature) from the CDC Core Elements and demonstration of outcomes from an intervention. The criteria for gold designation were silver criteria plus community engagement (ie, local work or collaboration with healthcare partners). Applications were evaluated in 3 phases: (1) CDPH reviewed core elements and documentation, (2) CDPH and external blinded antimicrobial stewardship experts reviewed outcomes as scientific abstracts, and (3) CDPH reviewed each program for overall effectiveness in antimicrobial stewardship and final designation determination. Designations expire after 2 years. Results: In total, 119 applications were submitted (30% of all ACHs in California), of which 100 were complete and thus were included for review. Moverover, 33 facilities were from northern California and 67 were from southern California. Also, 85 facilities were part of a health system or network, 14 were freestanding, and 1 was a district facility. Facility types included 68 community hospitals, 17 long-term acute-care (LTAC) facilities, 17 academic or teaching hospitals, 4 critical-access hospitals, and 4 pediatric hospitals. There was an even distribution of hospital bed size: 35 facilities had <250 beds. The final designations included 19 gold, 35 silver and 43 bronze designations. There was 44% incongruency in applicants not receiving the designation for which they applied. Community hospitals were 63%–74% of all designations, and no LTACs received a gold designation. Moreover, 63% of hospitals with gold designations had >250 beds, and 47% of hospitals with bronze designations had <1 25 beds. Conclusions: The number of applicants was higher than expected because the open enrollment period occurred during the COVID-19 pandemic. This finding demonstrates the high importance placed on antimicrobial stewardship among ACHs. It also provides insight into how facilities are performing and collaborating and how CDPH can support facilities to improve their ASP.Funding: NoDisclosures: None

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