250. Comparison of T2Candida Assay with Blood Culture, Candida Sepsis Score and Serum β-d-glucan in Diagnosis of Candidemia

Abstract Background Although blood cultures are the clinical diagnostic standard for candidemia, their delay in results and low sensitivity has lead to increasing the use of alternate tests and diagnostic algorithms. The T2Candida magnetic resonance assay (T2C) results in a few hours, but concomitant cultures are also needed. We compared results from the T2C with β-d-glucan (BDG), blood cultures (BCx) and the Candida Sepsis Score (CSc) in diagnosis and management of candidemia. Methods This retrospective observational study included patients from July 2017 to December 2018 who had a T2C as well as BCx. Positive (+) and negative (–) results of BCx and BDG within 24 hours (24 h) of T2C were recorded, with clinical data to determine CSc at the time of T2C (recent surgery, severe sepsis, parenteral nutrition, multifocal candida colonization). Results There were 648 T2Cs done over the study period. Only the first +T2C for patients with multiple T2Cs on admission was included. There were 41 patients with +T2, in which 31 had a 24hBCx. Two patients were of pediatric age. There were 7 neutropenic, 1 post-transplant, and 27 intensive care (ICU) patients. Reasons for ordering T2C included sepsis and persistent fevers. In 18 (44%) patients, antifungals were given prior to the T2C. Eight among 31 24hBCx were positive for concordant Candida spp. (26%). Six of these 8 patients were on antifungal therapy when T2C was sent. Seventeen patients had a 24hBDG, with 7 positive (41%). Overall mean CSc in 27 ICU patients with +T2C was 2.2 ± 0.8, and 40% of adult non-neutropenic ICU patients had a CSc of 3 or above. A central line was present in 26 patients, and was removed in 16 after +T2. In 213 patients with −T2C who had 24hBCx, only 1 BCx was positive, from a PICC line in a 2-year-old patient. Seven of the 41 patients with +T2C were treated for deep-seated candidiasis with 6 weeks antifungal therapy or longer; others received 1 to 4 weeks. Thirteen patients died while on antifungal therapy. Conclusion T2Candida was used for diagnosis and management of candidemia in patients who had concomitant blood culture positive in 26%, β-d-glucan positive in 41%, and ICU Candida sepsis score 3 or above in 40% patients. It did not miss candidemia in adults, compared with blood culture within 24 hours. Positive T2Candida helped expedite source control e.g line removal. Disclosures All authors: No reported disclosures.

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Efficacy of T2 Magnetic Resonance Assay in Monitoring Candidemia after Initiation of Antifungal Therapy: the Serial Therapeutic and Antifungal Monitoring Protocol (STAMP) Trial

Journal of Clinical Microbiology ◽

10.1128/jcm.01756-17 ◽

2018 ◽

Vol 56 (4) ◽

Cited By ~ 27

Author(s):

Eleftherios Mylonakis ◽

Ioannis M. Zacharioudakis ◽

Cornelius J. Clancy ◽

M. Hong Nguyen ◽

Peter G. Pappas

Keyword(s):

Magnetic Resonance ◽

Blood Culture ◽

Antifungal Therapy ◽

Small Sample Size ◽

Small Sample ◽

Blood Cultures ◽

Source Control ◽

Rank Test ◽

Duration Of Treatment ◽

Content Type

ABSTRACTThe performance of blood culture for monitoring candidemia clearance is hampered by its low sensitivity, especially during antifungal therapy. The T2 magnetic resonance (T2MR) assay combines magnetic resonance with nanotechnology to identify wholeCandidaspecies cells. A multicenter clinical trial studied the performance of T2MR in monitoring candidemia clearance compared to blood culture. Adults with a blood culture positive for yeast were enrolled and had blood cultures and T2MR testing performed on prespecified days. Thirty-one patients completed the trial. Thirteen of the 31 patients (41.9%) had at least one positive surveillance T2MR and/or blood culture result. All positive blood cultures (7/7 [100%]) had an accompanying positive T2MR result with concordance in the identifiedCandidasp., while only 7/23 (30.4%) T2MR results had an accompanying positive blood culture. There was one case of discordance in species identification between T2MR and the preenrollment blood culture with evidence to support deep-seated infection by theCandidaspp. detected by the T2MR assay. Based on the log rank test, there was a statistically significant improvement in posttreatment surveillance using the T2MR assay compared to blood culture (P= 0.004). Limitations of the study include the small sample size and lack of outcome data. In conclusion, the T2MR assay significantly outperformed blood cultures for monitoring the clearance of candidemia in patients receiving antifungal therapy and may be useful in determining adequate source control, timing for deescalation, and optimal duration of treatment. However, further studies are needed to determine the viability ofCandidaspecies cells detected by the T2MR assay and correlate the results with patient outcomes. (This study is registered at ClinicalTrials.gov under registration number NCT02163889.)

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81. Reducing Unnecessary Blood Cultures Through Diagnostic Stewardship

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.283 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S157-S157

Author(s):

Sujeet Govindan ◽

Luke Strnad

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Cost Savings ◽

Bloodstream Infections ◽

Central Line ◽

Blood Cultures ◽

Coagulase Negative Staphylococci ◽

Candida Sp ◽

Daily Frequency ◽

Oregon Health

Abstract Background At our institution, we learned the frequency of blood cultures was sometimes being changed from “Once” to “Daily” without a defined number of days. We hypothesized this led to unnecessary blood cultures being performed. Methods Over a 3 month period from 12/6/2019-3/6/2020, we retrospectively evaluated the charts of patients who had a blood culture frequency changed to “Daily”. We evaluated if there was an initial positive blood culture within 48 hours of the “Daily” order being placed and the number of positive, negative, or “contaminant” sets of cultures drawn with the order. Contaminant blood cultures were defined as a contaminant species, present only once in the repeat cultures, and not present in initial positive cultures. Results 95 unique orders were placed with 406 sets of cultures drawn from 89 adults. ~20% of the time (17 orders) the order was placed without an initial positive blood culture. This led to 62 sets of cultures being drawn, only 1 of which came back positive. 78/95 orders had an initial positive blood culture. The most common initial organisms were Staphylococcus aureus (SA) (38), Candida sp (10), Enterobacterales sp (10), and coagulase negative staphylococci (7). 43/78 (55%) orders with an initial positive set had positive repeat cultures. SA (26) and Candida sp (8) were most common to have positive repeats. Central line associated bloodstream infections (CLABSI) were found in 5 of the orders and contaminant species were found in 4 of the orders. 54% of the patients who had a “Daily” order placed did not have positive repeat cultures. The majority of the cultures were drawn from Surgical (40 orders) and Medical (35 orders) services. Assuming that SA and Candida sp require 48 hours of negative blood cultures to document clearance and other species require 24 hours, it was estimated that 51% of the cultures drawn using the "Daily" frequency were unnecessary. Cost savings over a year of removing the "Daily" frequency would be ~&14,000. Data from "Daily" blood culture orders drawn at Oregon Health & Science University from 12/6/2019-3/6/2020 Conclusion Unnecessary blood cultures are drawn when the frequency of blood cultures is changed to "Daily". Repeat blood cultures had the greatest utility in bloodstream infections due to SA or Candida sp, and with CLABSI where the line is still in place. These results led to a stewardship intervention to change blood culture ordering at our institution. Disclosures All Authors: No reported disclosures

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Invasive Fungal Infection in Febrile Patients with Hematologic Malignancies Undergoing Chemotherapy in Iran

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530319666190211163245 ◽

2019 ◽

Vol 19 (3) ◽

pp. 302-307 ◽

Cited By ~ 1

Author(s):

Saba Sheikhbahaei ◽

Alireza Mohammadi ◽

Roya Sherkat ◽

Alireza Emami Naeini ◽

Majid Yaran ◽

...

Keyword(s):

Blood Culture ◽

Antifungal Therapy ◽

Fungal Infections ◽

Hematologic Malignancy ◽

Hematologic Malignancies ◽

Fungal Species ◽

Antifungal Prophylaxis ◽

Invasive Fungal Infections ◽

Severe Neutropenia ◽

Candida Spp

Background: Patients with hematological malignancies undergoing cytotoxic chemotherapy are susceptible to develop invasive fungal infections particularly Aspergillus and Candida spp. Early detection of these infections is required to start immediate antifungal therapy and increase the survival of these patients. Method: Our study included consecutive patients of any age with hematologic malignancies who were hospitalized to receive chemotherapy and suffer from persistent fever (rectal temperature >38.5°C) for more than 5 days despite receiving broad-spectrum antibiotics. A whole blood sample was taken and sent for blood culture. PCR was also conducted for Aspergillus and Candida species. Results: One hundred and two patients were investigated according to the inclusion criteria. The most common hematologic malignancy was AML affecting 38 patients (37.2%). Six patients were diagnosed with invasive fungal infections (A. fumigatus n=3, C. albicans n=2, A. flavus n=1) by PCR (5.8%) while blood culture showed fungus only in 1 patient. Three more cases were known as probable IFI since they responded to antifungal therapy but the PCR result was negative for them. AML was the most prevalent malignancy in IFI patients (83.3%) and odds ratio for severing neutropenia was 21.5. Odds for each of the baseline characteristics of patients including gender, age>60, diabetes mellitus, previous IFI, history of using more than 3 antibiotics, antifungal prophylaxis, episodes of chemotherapy> 8 and chemotherapy regimen of daunarubicin+cytarabine were calculated. Conclusion: We found that multiplex real-time PCR assay is more accurate than blood culture in detecting fungal species and the results are prepared sooner. Among all factors, the only type of cancer (AML) and severe neutropenia, were found to be risk factors for the development of fungal infections in all hematologic cancer patients and previous IFI was a risk factor only AML patients.

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Central Line–Associated Bloodstream Infections in Adult Hematology Patients with Febrile Neutropenia An Evaluation of Surveillance Definitions Using Differential Time to Blood Culture Positivity

Infection Control and Hospital Epidemiology ◽

10.1086/668431 ◽

2013 ◽

Vol 34 (1) ◽

pp. 89-92 ◽

Cited By ~ 27

Author(s):

Joshua T. Freeman ◽

Anna Elinder-Camburn ◽

Catherine McClymont ◽

Deverick J. Anderson ◽

Mary Bilkey ◽

...

Keyword(s):

Blood Culture ◽

Febrile Neutropenia ◽

Positive Predictive Value ◽

Bloodstream Infections ◽

Central Line ◽

Blood Cultures ◽

National Healthcare ◽

Culture Positivity ◽

National Healthcare Safety Network ◽

Blood Culture Positivity

We used differential time to positivity between central and peripheral blood cultures to evaluate the positive predictive value (PPV) of the National Healthcare Safety Network central line–associated bloodstream infection (CLABSI) surveillance definition among hematology patients with febrile neutropenia. The PPV was 27.7%, which suggests that, when the definition is applied to this population, CLABSI rates will be substantially overestimated.

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Obtaining Blood Cultures by Venipuncture versus from Central Lines Impact on Blood Culture Contamination Rates and Potential Effect on Central Line–Associated Bloodstream Infection Reporting

Infection Control and Hospital Epidemiology ◽

10.1086/673142 ◽

2013 ◽

Vol 34 (10) ◽

pp. 1042-1047 ◽

Cited By ~ 26

Author(s):

John M. Boyce ◽

Jacqueline Nadeau ◽

Diane Dumigan ◽

Debra Miller ◽

Cindy Dubowsky ◽

...

Keyword(s):

Blood Culture ◽

Bloodstream Infection ◽

Hospital Costs ◽

Cost Savings ◽

Central Line ◽

Potential Effect ◽

Blood Cultures ◽

Blood Samples ◽

Central Lines ◽

Contaminated Blood

Objective.Reduce the frequency of contaminated blood cultures that meet National Healthcare Safety Network definitions for a central line-associated bloodstream infection (CLABSI).Design.An observational study.Setting.A 500-bed university-affiliated hospital.Methods.A new blood culture policy discouraged drawing blood samples from central lines. Phlebotomists were reeducated regarding aseptic technique when obtaining blood samples by venipuncture. The intravenous therapy team was taught how to draw blood samples by venipuncture and served as a backup when phlebotomists were unable to obtain blood samples. A 2-nurse protocol and a special supply kit for obtaining blood samples from catheters were developed. Rates of blood culture contamination were monitored by the microbiology laboratory.Results.The proportion of blood samples obtained for culture from central lines decreased from 10.9% during January–June 2010 to 0.4% during July–December 2012 (P< .001). The proportion of blood cultures that were contaminated decreased from 84 (1.6%) of 5,274 during January–June 2010 to 21 (0.5%) of 4,245 during January–June 2012 (P< .001). Based on estimated excess hospital costs of $3,000 per contaminated blood culture, the reduction in blood culture contaminants yielded an estimated annualized savings of $378,000 in 2012 when compared to 2010. In mid-2010, 3 (30%) of 10 reported CLABSIs were suspected to represent blood culture contamination compared with none of 6 CLABSIs reported from mid-November 2010 through June 2012 (P= 0.25).Conclusions.Multiple interventions resulted in a reduction in blood culture contamination rates and substantial cost savings to the hospital, and they may have reduced the number of reportable CLABSIs.

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The Role of Moderate and Virulent Endogenous Bacteriophages in the Treatment of Pyoinflammatory Infections in Intensive Care Unit Patients

Russian Sklifosovsky Journal Emergency Medical Care ◽

10.23934/2223-9022-2020-9-3-422-426 ◽

2020 ◽

Vol 9 (3) ◽

pp. 422-426

Author(s):

E. B. Lazareva ◽

T. V. Chernenkaya ◽

A. K. Shabanov ◽

N. V. Yevdokimova ◽

E. L. Zhilenkov ◽

...

Keyword(s):

Intensive Care ◽

Blood Culture ◽

Blood Cultures ◽

Icu Patients ◽

Blood Samples ◽

Blood Tests ◽

Men 2 ◽

Positive Treatment ◽

Staphylococcus Spp

Abstract. In connection with the growth of resistance of pathogens of pyoinflammatory infections (PII) to antibiotics, physicians began to use bacteriophages, which are widespread where there are homologous bacteria. They are also found in the human body, possibly protecting against PII. It was found that mortality in patients with bacteriophages was lower than in patients without homologous endogenous bacteriophages. The most common were mild bacteriophages, which “protected” patients from infection, although it is believed that only virulent bacteriophages may do this.Aim of study. To study the effect of virulent and moderate endogenous bacteriophages on the course of pyoinflammatory infections in intensive care units (ICU) patients.Material and methods. The study included 33 patients with positive blood culture who were treated in the ICU. Of these, 12 (36.4%) had endogenous bacteriophages (10 men, 2 women).We isolated 16 strains of various bacteria. Bacteriological blood tests were performed using an automatic blood culture analyzer Bactec-9050. Identification of isolated microorganisms was carried out using an automatic microbiological analyzer WalkAway 40. Traditional virological methods on the basis of LLC SPC MicroMir were used for work with bacteriophages.Results and discussion. From 16 positive blood cultures, the following were isolated: Klebsiella pneumoniaе — in 7 samples, Acinetobacter spр. — in 4 samples, Staphylococcus spp. — in 2 samples, and one strain in each sample: Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecalis. Endogenous phages were isolated in 36.4% of patients, which were detected in all blood cultures. The exception was K. pneumoniae strains, for which in 42.9% of cases (3 cases out of 7) bacteriophages were absent.Out of 12 patients with isolated bacteriophages, 6 had positive treatment outcomes.Of 14 blood samples, 11 moderate bacteriophages were isolated, which amounted to 78.6%, virulent — 21.4%. Despite this, the protective effect of bacteriophages was noted.Conclusion. 1. All blood cultures contained homologous bacteriophages, except K. pneumoniaе strains, which had no endogenous bacteriophages in 42.9% of cases. 2. Most of the isolated endogenous bacteriophages (78.6%) were moderate. 3. In the absence of homologous bacteriophages in the blood of ICU patients, the likelihood of death increases (66.7%) compared to patients with bacteriophages (33.3%).

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298. Multicenter retrospective cohort study of the clinical significance of Staphylococcus lugdunensis isolated from a single blood culture set

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.341 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S147-S148

Author(s):

Naomi Hauser ◽

Justin Kim ◽

Paul Luethy ◽

Sarah Schmalzle ◽

Jacqueline Bork

Keyword(s):

Blood Culture ◽

Clinical Significance ◽

Positive Blood Culture ◽

Positive Culture ◽

Central Line ◽

Blood Cultures ◽

Adult Patients ◽

Coagulase Negative Staphylococcus ◽

Staphylococcus Lugdunensis ◽

Clinical Criteria

Abstract Background Staphylococcus lugdunensis is a coagulase negative Staphylococcus (CoNS) species with the potential to cause aggressive infection. Guidance surrounding S. lugdunensis bacteremia (SLB) is lacking, especially in the case of a single positive set of blood cultures. Methods We performed a multicenter, retrospective observational cohort review of adult patients with SLB from at least one blood culture set within the University of Maryland Medical System from November 2015-November 2019. Objectives were to (1) describe baseline characteristics, (2) compare available criteria for evaluating clinical significance, and (3) evaluate the clinical outcomes among patients with SLB in 1 vs ≥2 positive blood culture sets. Descriptive statistics with Chi-squared and Mann-Whitney U tests were carried out. Results There were 5,548 CoNS-positive blood culture sets, 49 (0.88%) with S. lugdunensis comprising 36 adult patients (24 with 1 positive set and 12 with ≥2 positive sets). Patients with ≥2 positive sets were more likely to be on hemodialysis (HD) (p=0.029) and to have an HD catheter present (p=0.10) (Table 1). Thirty-five of the 36 patients fulfilled at least one of the following: systemic inflammatory response syndrome (SIRS), Souvenir criteria, or clinical criteria (infectious focus on imaging and/or second positive culture site) (Table 2). Twenty-eight (78%) patients were treated with antimicrobial therapy and/or central line removal. SIRS criteria were met more often among patients with 1 positive set (p=0.05). Patients with ≥2 positive sets were more often treated with antibiotics for longer than 2 weeks (p=0.02). The mean time of positive cultures to discharge was 11 days and was longer for patients with only one set of positive blood cultures (13 vs. 6 days), although this difference was not statistically significant (p=0.29) (Table 3). Conclusion SLB was rare and occurred more frequently as a single set of positive blood cultures. Though limited by sample size, this study found similar patient characteristics, clinical significance and outcomes between patients with one set and those with ≥2 sets of blood cultures positive for S. lugdunensis. Given the potential severity of SLB, it seems prudent to treat S. lugdunensis in a single blood culture, but larger studies are needed. Disclosures All Authors: No reported disclosures

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1169. Preventing Central Line-Associated Bloodstream Infections in Long-Term Acute Care

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1032 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S418-S419

Author(s):

Jerry Jacob ◽

Ann Morace ◽

Jisuk Park ◽

Nina Renzi

Keyword(s):

Blood Culture ◽

Bloodstream Infections ◽

Central Line ◽

Culture Collection ◽

Blood Cultures ◽

Fiscal Year ◽

Intervention Period ◽

Central Lines ◽

Clabsi Rate

Abstract Background Long-term acute care hospitals (LTACHs) care for chronically, critically ill patients with high utilization of central lines and high risk for morbidity from central line-associated bloodstream infections (CLABSIs). Our 38-bed LTACH noted a substantial increase in the incidence of CLABSIs (as defined by the National Healthcare Safety Network) between fiscal year (FY) 2016 and FY 2018 (Figure 1). Detailed case review identified a large number of CLABSIs which were clinically consistent with blood culture contaminants from central lines. Feedback from bedside staff also suggested gaps between practice and evidence-based measures for central line care. Methods A three-pronged CLABSI prevention project was implemented in July 2018 consisting of (1) staff education regarding daily chlorhexidine (CHG) bathing for all patients, combined with an electronic audit report to identify patients without active CHG orders; (2) change in practice to the use of venipuncture alone for blood culture collection, combined with an electronic audit report to identify blood cultures collected from central lines; and (3) a recurring 6-part educational series for nurses focused on central line care. The pre-intervention period was defined as the 12-month period between July 1, 2017 and June 30, 2018 (FY 2018). The primary outcome was the fiscal year CLABSI rate. A secondary outcome was the proportion of blood cultures drawn from central lines. Results After 9 months of the intervention, one CLABSI had been reported for FY 2019 year-to-date at a rate of 0.4 per 1,000 CL-days, representing an 86% decrease from the FY 2018 rate of 2.8 per 1,000 CL-days. The 12-month rolling CLABSI rate decreased to 1.6 per 1,000 CL-days (Figure 2). The proportion of blood cultures collected from central lines decreased from 10.5% (69/658) to 4.5% (15/334), representing a 57% reduction. The proportion of patients ordered and receiving CHG bathing in the intervention period was >95%. Conclusion A multidisciplinary effort focused on CHG bathing, central line care, and blood culture collection led to a substantial reduction in CLABSIs in our LTACH. The use of electronic audit reports was particularly useful in achieving high adherence to practice changes. Disclosures All authors: No reported disclosures.

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Blood Culturing Practices at an Academic Medical Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.657 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s142-s143

Author(s):

Priya Sampathkumar ◽

Kyle Rodino ◽

Stacy (Tram) Ung

Keyword(s):

Blood Culture ◽

Care Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Central Line ◽

Blood Cultures ◽

High Rate ◽

Contamination Rate ◽

Blood Samples ◽

Central Lines

Background: Blood cultures are part of the evaluation of hospital patients with fever. Patients with central lines in place, frequently have blood samples for culture drawn through lines. We sought to assess blood culturing practices at our institution. Methods: Retrospective review of BCs performed in hospitalized patients over a 12-month period (August 2018–July 2019) at an academic, tertiary-care center with 1,297 licensed beds and >62,000 admissions a year. A specialized phlebotomy team is involved in all peripherally drawn blood samples; however, the patient’s nurse obtains a blood sample through a central line. Results: Overall, 35,121 blood cultures were performed for an incidence rate of 106 BC per 1,000 patient days or 566 blood cultures per 1,000 admissions. Most blood samples (67%) were collected via peripheral venipuncture. We detected significant variation in culturing rates and the proportion of blood samples obtained through central lines among collecting units (Table 1). Overall, the blood culture contamination rate was 1.6%. Blood samples obtained through a central line had a higher contamination rate (2.2%) compared to samples obtained through peripheral venipuncture (1.3%; P < .0001). Blood culture rates were highest in intensive care units (ICUs) compared with other types of patient care units (Table 1). The blood culture positivity rate was significantly lower in ICUs (8.8%) compared with hematology-oncology (10%; HR, 0.88; CI, 0.80–0.96; P = .006), general medicine (10%; HR, 0.88; CI, 0.80–0.97; P = .013), and pediatrics (12%; HR, 0.74; CI, 0.59–0.92; P = .008). The ICUs had the lowest rate of BC contamination at 1.3%. Conclusions: Blood samples obtained through central lines for culture are more likely to be contaminated than peripherally drawn blood samples. Despite a relatively high rate of line-drawn blood samples for culture, ICUs had the lowest BC contamination rate, possibly reflecting high familiarity of ICU nurses with line draws. Blood samples collected through lines were most frequently performed in pediatrics and hematology-oncology, and these units had correspondingly higher rates of contamination. This information will be used to inform institutional guidelines on blood culturing and to identify ways to minimize blood culture contamination, which often results in additional testing and/or unnecessary antimicrobial use.Funding: NoneDisclosures: Consulting fee- Merck (Priya Sampathkumar)

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160. Could Reducing Time to Bacterial Identification From Positive Blood Cultures Improve Outcomes in Bacteremic Patients?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.235 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S105-S105

Author(s):

Jessica D Forbes ◽

Reem Haj ◽

Linda R Taggart ◽

Ramzi Fattouh ◽

Elizabeth Leung ◽

...

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Patient Management ◽

Diagnostic Testing ◽

Empiric Therapy ◽

Central Line ◽

Blood Cultures ◽

Antibiotic Administration ◽

Organism Identification ◽

The Impact

Abstract Background Survival of patients with septic shock is dependent on the timing of effective antibiotic administration. The initial notification by the microbiology lab of a positive blood culture is a key factor in improving patient outcomes. It can take >24 hours to definitively identify bacteria from positive blood cultures. Accordingly, we employed rapid organism identification and studied the impact of this on patient management from a quality improvement perspective. Methods Rapid organism identification was performed for bacteremic patients admitted to an ICU at St. Michael’s Hospital in Toronto, ON, by creating a pellet from positive blood culture bottles using a lysis centrifugation technique. MALDI-TOF was then used to obtain an organism identification. The microbiology lab verbally notified the ward clerk of the identification and surveys were conducted with treating physicians within 24–48 hours to evaluate the downstream impact of the rapid identification including changes to antibiotics, diagnostic testing, central line management and requests for specialty consultations. Results Between January 28 and April 28, 2019, 17 rapid blood culture results were included for study. When asked how physicians received the result, in 7 cases the physician did not remember; other responses included microbiology report (2), nurse (2), pharmacist (1), antimicrobial stewardship or lab (1), on-call team (1) and residents (1). Antibiotics were adjusted in 13 patients; 3 of which may have changed antibiotics for reasons other than the organism identification. Reasons for not changing therapy include: appropriate empiric treatment, likely contaminants, or physician not being notified of the result. In 5 cases, all antibiotics were discontinued, in another 2 cases the antibiotics were broadened and a further 5 narrowed to cover the organism; the remaining 5 continued the same empiric therapy. Repeat blood cultures were obtained for 5 cases, follow-up imaging in 5 cases and lines were changed/removed in 5 cases. Consultation was requested for 7 cases. Conclusion Based on preliminary data, rapid organism identification shows promise of improved patient management with line removal and antibiotics adjustments occurring 1 day sooner with rapid results. Disclosures All authors: No reported disclosures.

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