scholarly journals Susceptibility Pattern of Pathogens Causing Blood Stream Infections in a Tertiary Care Hospital: A Two-year Retrospective Study from Southern Nigeria

2021 ◽  
pp. 53-60
Author(s):  
Bassey Ewa Ekeng ◽  
Ubleni Ettah Emanghe ◽  
Bernard Ekpan Monjol ◽  
Anthony Achizie Iwuafor ◽  
Ernest Afu Ochang ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Blood Stream ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Disc Diffusion ◽  
Blood Stream Infections ◽  
Gram Negative ◽  
Antimicrobial Sensitivity ◽  
Culture Positive

Aim: Bloodstream infections are a major cause of morbidity and mortality worldwide. The prevalence of causative microorganisms varies from one geographical region to another. This study was aimed at determining the etiological agents prevalent in our environment and their susceptibility profile. Study design: This is a retrospective study carried out at the University of Calabar Teaching Hospital, Calabar, Nigeria. Methodology: Blood culture results of patients documented over a two-year period were retrieved and analyzed. Blood culture positive isolates were detected using conventional method and Oxoid signal blood culture systems. Antimicrobial sensitivity tests were carried out by Kirby-Bauer disc diffusion method. Methicillin resistance in Staphylococcus aureus and coagulase negative Staphylococcus species (CoNS) was detected by disk diffusion method using 30 µg cefoxitin disk. ESBL production was detected by phenotypic confirmatory disc diffusion test (PCDDT) and the double disc synergy test (DDST). Results: A total of 413 blood culture antimicrobial susceptibility test results were analyzed, of which 116 (28.09%) were identified as culture positive. Sixty-nine (59%) of the positive isolates were from female patients. Out of 116 positive cultures, 58.62% (68/116) were Gram positive organisms, 40.52% (47/116) were Gram negative organisms, non albicans Candida accounted for 0.86% (1/116).  Staphylococcus aureus (n=41, 35.3%) was the predominant isolate and showed high sensitivity to levofloxacin (100%), Linezolid (100%) and Amikacin (100%). Twelve isolates of S. aureus were methicillin resistant, while 1 isolate was inducible clindamycin resistant. Of the 116 isolates identified in this study, forty-three (43) were multidrug resistant with highest number of multidrug resistant isolates from Staphylococcus aureus (n=20). 21.28% (n=10) of the Gram-negative isolates were positive for extended spectrum beta lactamases. Conclusion: A high rate of antimicrobial resistance is observed among microorganisms causing blood stream infections. This emphasizes the need for antimicrobial sensitivity testing in the management of blood stream infections.

scholarly journals Study of Aerobic Bacterial Etiology and Their Antibiogram from Pus Samples in a Tertiary Care Hospital

2021 ◽  
Vol 8 (4) ◽  
pp. 358-362
Author(s):  
T. Kanakadurgamba ◽  
Rama Lakshmi Koripella ◽  
B. Gowtham
Keyword(s):  
Staphylococcus Aureus ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Resistant Bacteria ◽  
Klebsiella Pneumonia ◽  
Microbiological Analysis ◽  
Gram Positive ◽  
Gram Negative ◽  
Culture Positive ◽  
Gram Positive Cocci

Introduction: The spread of multidrug resistant bacteria has added a new angel to the problem of wound infections which are a major cause of morbidity. To avoid difficulty in treatment of such infections it is mandatory for every pus sample to undergo Culture and sensitivity. Aim: To isolate and study the antibiogram of the aerobic bacteria from pus samples. Materials and Methods: A total of 426 pus samples received from various wards in the Microbiology department. Andhra Medical College, Visakhapatnam were processed as per standard guidelines in the laboratory. All the aerobic bacterial isolates obtained were kept for antibiogram by Kirby Bauer’s disc diffusion method as per CLSI Guidelines. Results: Out of 426 samples 394 (92.4%) were culture positive. Among culture positive samples 90.6% were pure cultures and 9.4% were mixed isolates. Gram negative bacilli were 72.8% of the total isolates and 27.2% were Gram positive cocci. Escherichia coli and Klebsiella pneumonia were the predominant isolates (30.3% and 28.9%) followed by Pseudomonas aeruginosa (24%), Proteus species (9.7%) and Acinetobacter species (6.9%). Among Gram positive cocci Staphylococcus aureus (62.6%), Enterococci (20.5%) and Coagulase Negative Staphylococcus (11.2%) and Streptococci (3.7%). GNB were more sensitive to Colistin (92%), Amikacin (86%), Imipenem and Meropenem (86% and 84.4%), Piperacillin Tazobactam (84%), Gentamycin (78%), Cefaperazone Sulbactam (76.2%) and Ciprofloxacin (56%). Gram positive cocci were sensitive to Linezolid and Teicoplanin (98% each), Vancomycin (96.2%), Clindamycin (84%), Gentamycin (79%), Azithromycin (76.4%), Ciprofloxacin (66%) and Amoxiclav (54%) out of 62.6% Staphylococcus aureus isolates 31.4% were MRSA and out of 72.8% of Gram negative bacilli 38.2% were ESBLS. Conclusion: As multidrug resistant bacterial strains are emerging in various infectious and pyogenic wound infection is most important cause of morbidity, it is important for a clinician to send all pus samples for microbiological analysis and their antibiogram before putting cases on antibiotics. Keywords: Pus samples, Multidrug resistance, Gram negative bacilli, Gram positive cocci, Antimicrobial sensitivity.

scholarly journals Staphylococcal Blood Stream Infections: Epidemiology, Resistance Pattern and Outcome at a Level 1 Indian Trauma Care Center

2013 ◽  
Vol 5 (01) ◽  
pp. 46-50 ◽  
Author(s):  
Vibhor Tak ◽  
Purva Mathur ◽  
Sanjeev Lalwani ◽  
Mahesh Chandra Misra
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Blood Stream ◽  
Diffusion Method ◽  
Resistance Pattern ◽  
Coagulase Negative Staphylococcus ◽  
Blood Stream Infections ◽  
Blood Samples ◽  
Crude Mortality ◽  
Level 1

ABSTRACT Purpose: Blood stream infection (BSI)/bacteremia is a potentially life threatening infection and are associated with a high crude mortality. Coagulase negative Staphylococcus (CONS) and Staphylococcus aureus are the most commonly isolated gram positive bacteria from blood culture samples. While S. aureus is a known pathogen causing BSIs, CONS are considered to be common contaminants of blood culture. Of late many studies have challenged this traditional viewpoint. The aim of this study was to determine the epidemiology and significance of Staphylococcus aureus and CONS bacteremia, their resistance patterns and associated mortality in critically ill trauma patients admitted to a level 1 trauma center. Materials and Methods: The study was conducted from January 2009 to June 2011. All patients from whose blood samples yielded a S. aureus or CONS on culture were included in this study. A detailed history was obtained and follow-up of the patients was done. The isolates of Staphylococci were identified to species level. Antibiotic susceptibility was performed by the disc diffusion method and VITEK-2 system. Results: During this 30 month period, total of 10,509 blood samples were received from 2,938 patients. A total of 1,961 samples taken from 905 patients were positive for one or more pathogens. S. aureus/CONS were isolated from 469 samples from 374 patients. Crude mortality amongst the patients having Staphylococcal BSI was 25% (94/374). Conclusion: Staphylococcal blood stream infections are a leading cause of morbidity and mortality.

ANTIMICROBIAL SUSCEPTIBILITY IN CULTURE POSITIVE ENTERIC FEVER

2019 ◽  
Vol 3 (7) ◽  
Author(s):  
Dr. Manish Kulshrestha ◽  
Dr. Anjali Kulshrestha
Keyword(s):  
Bone Marrow ◽  
Blood Culture ◽  
Nalidixic Acid ◽  
Antimicrobial Susceptibility ◽  
Salmonella Enterica ◽  
Enteric Fever ◽  
Multidrug Resistant ◽  
Bone Marrow Culture ◽  
Diffusion Method ◽  
Culture Positive

INTRODUCTION: Enteric fever includes typhoid and paratyphoid fever. Peak incidence is seen in children 5–15 years of age; but in regions where the disease is highly endemic, as in India, children younger than 5 years of age may have the highest infection rates. There are about 22 million new typhoid cases occur each year. Young children in poor, resource limited areas, who make up the majority of the new cases and there is a mortality figures of 215,000 deaths annually. A sharp decline in the rates of complications and mortality due to typhoid fever is observed as a result of introduction of effective antibiotic therapy since 1950s. MDR-ST became endemic in many areas of Asia, including India soon after multidrug-resistant strains of Salmonella enterica serotype typhi (MDR-ST) that were resistant to all the three first-line drugs then in use, namely chloramphenicol, amoxycillin and co-trimoxazole emerged in early 1990s. MATERIAL AND METHODS: Only blood culture or bone marrow culture positive cases were included. The patients with culture isolated enteric fever were included in the study. Antimicrobial susceptibility testing was carried out by disk diffusion method using antibiotic discs. The analysis of the antimicrobial susceptibility was carried out as per CLSI interpretative guidelines. RESULTS: A total of 82 culture positive cases were included in the present study. 80 culture isolates were from blood culture and 2 from the bone marrow culture. Salmonella entericasubspecies enterica serovartyphi (S typhi) was isolated from 67 (81.70%) patients while Salmonella enterica subspecies entericaserovarparatyphi (S paratyphi A) was isolated from 13 (15.85%) cases and 2 (2.44%) were Salmonella enterica subspecies entericaserovarschottmuelleri (S paratyphi B). Of the 82 cases 65(79.3%) isolates were resistant to ciprofloxacin, 17 (20.7%) were resistant to nalidixic acid, one (1.2%) case each was resistant to Cefotaxime and ceftriaxone, 2 (2.4%) were resistant to chloramphenicol, 10 (12.2%) were resistant and to cotrimoxazole 3 (3.7%) were resistant. CONCLUSION: In a culture positive cases 65(79.3%) isolates were resistant to ciprofloxacin and 17 (20.7%) were resistant to nalidixic acid. Multidrug resistant isolates were 65(79.3%).

scholarly journals Spectrum of non-fermenting gram negative bacilli isolated from patients with blood stream infections in a tertiary care hospital in North India

2019 ◽  
Vol 7 (5) ◽  
pp. 1762
Author(s):  
Asifa Nazir ◽  
Bushra Yousuf Peerzada ◽  
Ifshana Sana
Keyword(s):  
Blood Culture ◽  
Antibiotic Susceptibility ◽  
Tertiary Care ◽  
Blood Stream ◽  
Control Measures ◽  
Care Hospital ◽  
Susceptibility Pattern ◽  
Intrinsic Resistance ◽  
Blood Stream Infections ◽  
Gram Negative

Background: Non-fermenting Gram-negative bacilli (NFGNB) are emerging as important causes of blood stream infections (BSI) and they are a major cause of morbidity and mortality worldwide. High intrinsic resistance of NFGNB to antimicrobial compounds makes the treatment of BSIs caused by them difficult and expensive. The aim of this study was to assess frequency and antibiotic susceptibility pattern of non-fermenting gram-negative rods isolated from blood culture of patients.Methods: A total of 3016 blood samples were received in the Department of Microbiology during the study period. All samples were processed according to standard microbiological procedures. Blood culture was done by automated blood culture system, (BacT/Alert) and identification and antibiotic susceptibility of non-fermenting gram negative bacilli was done by VITEK2 Compact System.Results: A total of 120 NFGNB were identified out of which the most common non-fermenters isolated were Acinetobacter sp. (95) followed by Pseudomonas aeruginosa (11), Burkholderia cepacia (09) Sternotrophomonas maltophilia (03) and Sphingomonas sp. (02). Most of the non -fermenters were multi drug resistant showing a high level of antibiotic resistance to most of the first- and second-line drugs. The most effective drugs were colistin and tigecycline.Conclusions: This study underlines the need to identify NFGNB in tertiary care hospitals and to monitor their susceptibility pattern to guide the clinician for better care and management of patients. Improved antibiotic stewardship and strict infection control measures especially hand washing need to be implemented to prevent emergence and spread of multidrug resistant NFGNB in health care settings.

scholarly journals Catheter-related blood stream infections in hemodialysis patients

2020 ◽  
Vol 9 (4) ◽  
pp. e34-e34
Author(s):  
Babak Hadian ◽  
Azita Zafarmohtashami ◽  
Mahdi Razani
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Signs ◽  
Blood Stream ◽  
Multidrug Resistant ◽  
Hemodialysis Patients ◽  
Empirical Treatment ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Negative Organisms ◽  
Clinical Records

Introduction: Proper care of vascular access in hemodialysis patients is important. Catheter-related bloodstream infection (CRBSI), is a life-threatening complication of hemodialysis. Objectives: Sufficient data about microorganisms and their susceptibility to antibiotics in hemodialysis patients is necessary for handling of CRBSI; therefore, this study performed for better management of patients. Patients and Methods: All hemodialysis patients from March 2015 to March 2018 who had cultures of catheter and blood samples were studied. Clinical records of 122 patients were reviewed for variables such as catheter and blood culture microorganism types, antibiotic resistance, age, gender, site, comorbidities, and various clinical signs. Results: Eighty-four cases of catheter cultures were positive for bacteria. Staphylococcus epidermidis was the most common organism (36%) since Staphylococcus aureus was the second one (28%). In some cases, multidrug resistant organisms such as Enterobacter baumannii or methicillin-resistant Staphylococcus aureus (MRSA) organisms were grown. Twenty-one percent of S. aureus organisms were MRSA. No significant association between important diagnostic data (fever, chills or WBC count) and bacteremia were shown. Gender of patients had a significant statistical association with CRBSI. Conclusion: Given the necessity of proper management, physicians must empirically initiate antibiotic therapy as soon as possible, until receiving definite culture results, in hemodialysis patients suspected of bacteremia. In our study, both gram-positive and gram-negative organisms were common. Hence, when initial empirical treatment is indicated, the coverage of both gram positive and gram negative organisms must be considered. Vancomycin or other antibiotics that are effective on MRSA must be included in empirical treatment.

scholarly journals Incidence of secondary blood stream infections in Covid 19 (SARS-nCoV II.) patients

2021 ◽  
Vol 8 (2) ◽  
pp. 128-131
Author(s):  
Asmabanu Shaikh ◽  
Rachana Patel ◽  
Anant Marathe
Keyword(s):  
Blood Culture ◽  
Blood Stream ◽  
Blood Cultures ◽  
Automated System ◽  
Empiric Antibiotic Therapy ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Blood Stream Infections ◽  
Gram Negative ◽  
Gram Positive Bacteria

The symptomatology and severity of covid-19 ranges widely depending on stage of infection. Most of the patients with mild to moderate disease can be managed without hospitalization. The patients with risk factors are likely to progress to severe disease. Patients developing secondary blood stream infections require longer hospital stay and are likely to develop fatal disease. The antibiotic selection is key to successful treatment of secondary BSI. This is cross-sectional study of 166 COVID 19 patients admitted to ICU of Parul Sevashram Hospital who developed sepsis like syndrome and were subjected to blood culture.Blood cultures were performed of all the patients developing sepsis like syndrome. IDSA guidelines were followed during blood collection for culture. Blood cultures were monitored on automated blood culture system. ID and susceptibility of all the isolates were performed on automated system (VITEK 2).A total of 1915 patients were reported RT-PCR positive for SARS nCoV2 during the period of 1st March2020 to 30 October 2020. 452 patients needed hospitalization based on their Oxygen saturation and co-morbidities. Out of 452, 166 patients developed sepsis like syndrome and were subjected to blood culture. The Blood culture positivity was 37/166 (22.28%). Gram positive bacteria were found in 48.64% while gram negative bacteria were 43.24%. The Enterococcus was the most common Gram positive bacterial isolates in patients. Candida was isolated in 2/37 positive blood cultures. Gram negative bacteria were isolated mostly amongst those patients who were on Ventilator. Most of the Gram positive bacteria were sensitive to Clindamycin, Linezolid, Vancomycin, Daptomycin and Teicoplanin.The incidence rate of BSI was high. Early secondary blood stream infections were mostly endogenous. Enterococcus was the most common amongst Gram positive bacteria. Gram negative secondary bacterial infections were more common with patients on ventilator. The susceptibility pattern would help in decision making of empiric antibiotic therapy. Interestingly as described by some authors earlier the relationship between SARS nCoV 2 and Enterococci needs to be studied further.

scholarly journals BACTERIOLOGICAL STUDY AND ANTIMICROBIAL SENSITIVITY PATTERN IN CASES OF OSTEOMYELITIS

2020 ◽  
pp. 1-2
Author(s):  
Spriha Smriti ◽  
Babita Kumari ◽  
Pratulya Nandan
Keyword(s):  
Staphylococcus Aureus ◽  
Diffusion Method ◽  
Disc Diffusion ◽  
Disc Diffusion Method ◽  
Bacteriological Study ◽  
E Coli ◽  
Antimicrobial Sensitivity ◽  
Common Organism ◽  
Sensitivity Pattern ◽  
Bone Cortex

Introduction- Osteomyelitis refers to infection of bone marrow which spread to the bone cortex and periosteum. Osteomyelitis is most commonly caused by pyogenic bacteria. Despite greater advances in treatment the management of osteomyelitis is quite challenging due to increasing development of antibiotic resistance. Material and Methods -100 patients were evaluated. Samples like pus or exudates or pieces of necrotic tissue were taken. Samples were subjected to gram’s staining and culture. Antimicrobial sensitivity was done using Kirby Bauer disc diffusion method. RESULTS - Staphylococcus aureus was the most common organism isolated followed by E.coli, Klebsiella pneumoniae P. aeuroginosa and Proteus. Staphylococcus aureus + E coli was the most common polymicrobial organism isolated. In trauma cases most common organism isolated was Staphylococcus aureus. Gentamycin was the commonest antibiotic which was effective for treatment of osteomyelitis followed by amikacin, tobramycin and levofloxacin.In cases of gram positive organism max were seen to sensitive to vancomycin and linezolid.

scholarly journals PATHOGENS CAUSING BLOOD STREAM INFECTIONS

2015 ◽  
Vol 22 (12) ◽  
pp. 1617-1623
Author(s):  
Muhammad Saeed ◽  
Farhan Rasheed ◽  
Fouzia Ashraf ◽  
Shagufta Iram ◽  
Shahida Hussain ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Cardiac Surgery ◽  
Blood Culture ◽  
Blood Stream ◽  
Cross Sectional Study ◽  
Blood Cultures ◽  
Gram Positive ◽  
Cross Sectional ◽  
Blood Stream Infections ◽  
Gram Negative

Blood stream infections (BSI) remain a major cause of debility and death aroundthe world. BSI accounts for 10-20% of all Nosocomial infections. Empirical antimicrobials arebased on the susceptibility pattern of the pathogens isolated in a specific institute from timeto time. We have conducted this study only on cardiac Patients over two & half years of studyduration. Study design: Cross sectional study. Settings: Microbiology Department, Allama IqbalMedical College/Jinnah Hospital, Lahore. Study Period: January 2013 to July 2015. Materials& Methods: A total of 5411 blood culture specimens were collected from cardiac patientsincluding patients admitted to cardiology ward, coronary care unit (CCU), pre-operative andpost-operative cardiac surgery patients. The bottles containing BHI broth were incubated andwere subcultured after 24 hours, 72 hours, 120 hours, and 168 hours on blood and MacConkeyagars. Isolates were further identified with the help of Gram staining, biochemical reactionsand rapid tests like catalase, oxidase, coagulase, Analytical Profile Index (API) 20E and API20NE. Antimicrobial susceptibility of the isolate was carried out on Mueller-Hinton agar byModified Kirby Bauer disc diffusion technique according to the isolate as per recommendationsof Clinical and Laboratory Standards Institute (CLSI) guidelines 2013. Results: Out of total 5411patients, 3958(73.14%) were male, 1453(26.85%) were females. Out of total 5411 Specimens,only 486 (8.98%) were positive for bacterial growth. Out of total 486 positive blood cultures,261 (53.71%) were Gram positive isolates and 225 (46.29%) were Gram negative isolates.Out 486 positive blood cultures, 96 (19.75%) were from cardiology ward, 67 (13.78%) werefrom CCU, 113 (23.25%) were from pre operative cardiac surgery ward, 210 (43.20%) werefrom post operative cardiac surgery ward. Among Gram positives, Staphylococcus Specieswere most common organism isolated from 246 (50.61%) blood culture specimens. AmongGram negatives, Pseudomonas aeruginosa and E.coli were predominant organisms, isolatedfrom 81(16.66%) and 72(14.81%) blood culture specimens respectively. Conclusion: GramPositive isolates were more common as compared to Gram negative isolates. Vancomycin andLinezolid were the most effective drugs among Gram positive isolates. Piperacillin-Tazobactamwas most potent antimicrobial against Pseudomonas aeruginosa. For coli forms Tigecyclinewas most effective drug.

scholarly journals Is it actionable? An Evaluation of the Rapid PCR-Based Blood Culture Identification Panel on the Management of Gram-Positive and Gram-Negative Blood Stream Infections

2018 ◽  
Author(s):  
Andrew S. Tseng ◽  
Sabirah N. Kasule ◽  
Felicia Rice ◽  
Lanyu Mi ◽  
Lynn Chan ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antimicrobial Therapy ◽  
Blood Stream ◽  
Gram Positive ◽  
Blood Stream Infections ◽  
Gram Negative ◽  
Discharge Disposition ◽  
Significant Difference ◽  
Culture Identification ◽  
Organism Identification

ABSTRACTBackgroundThere is growing interest in the use of rapid blood culture identification (BCID) panels in antimicrobial stewardship programs (ASP). While many studies have looked at its clinical and economic utility, its comparative utility in gram-positive and gram-negative blood stream infections (BSI) have not been as well characterized.MethodsThe study was a quasi-experimental retrospective study at the Mayo Clinic in Phoenix, Arizona. All adult patients with positive blood cultures before BCID implementation (June 2015 to December 2015) and after BCID implementation (June 2016 to December 2016) were included. The outcomes of interest included: time to first appropriate antibiotic escalation, time to first appropriate antibiotic de-escalation, time to organism identification, LOS, infectious disease consultation, discharge disposition, and in-hospital mortality.ResultsIn total, 203 patients were included in this study. There was a significant difference in the time to organism identification between pre- and post-BCID cohorts (27.1h vs. 3.3h, p<0.0001). BCID did not significantly reduce the time to first appropriate antimicrobial escalation or de-escalation for either GP-BSIs or GN-BSIs. Providers were more likely to escalate antimicrobial therapy in GP-BSIs after gram stain and more likely to de-escalate therapy in GN-BSIs after susceptibilities. While there were no significant differences in changes in antimicrobial therapy after organism identification by BCID, over a quarter of providers (28.1%) made changes after organism identification.ConclusionsWhile BCID significantly reduced the time to identification for both GP-BSIs and GN-BSIs, BCID did not reduce the time to first appropriate antimicrobial escalation and de-escalation.

scholarly journals Is It Actionable? An Evaluation of the Rapid PCR-Based Blood Culture Identification Panel on the Management of Gram-Positive and Gram-Negative Blood Stream Infections

2018 ◽  
Vol 5 (12) ◽  
Author(s):  
Andrew S Tseng ◽  
Sabirah N Kasule ◽  
Felicia Rice ◽  
Lanyu Mi ◽  
Lynn Chan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Hospital Mortality ◽  
Antimicrobial Therapy ◽  
Blood Stream ◽  
Gram Positive ◽  
Blood Stream Infections ◽  
Gram Negative ◽  
Culture Identification ◽  
Organism Identification

Abstract Background There is growing interest in the use of rapid blood culture identification (BCID) in antimicrobial stewardship programs (ASPs). Although many studies have looked at its clinical and economic utility, its comparative utility in gram-positive and gram-negative blood stream infections (BSIs) has not been as well characterized. Methods The study was a quasi-experimental retrospective study at the Mayo Clinic in Phoenix, Arizona. All adult patients with positive blood cultures before BCID implementation (June 2015 to December 2015) and after BCID implementation (June 2016 to December 2016) were included. The outcomes of interest included time to first appropriate antibiotic escalation, time to first appropriate antibiotic de-escalation, time to organism identification, length of stay, infectious diseases consultation, discharge disposition, and in-hospital mortality. Results In total, 203 patients were included in this study. There was a significant difference in the time to organism identification between the pre- and post-BCID cohorts (27.1 hours vs 3.3 hours, P &lt; .0001). BCID did not significantly reduce the time to first appropriate antimicrobial escalation or de-escalation for either gram-positive BSIs (GP-BSIs) or gram-negative BSIs (GN-BSIs). Providers were more likely to escalate antimicrobial therapy in GP-BSIs after gram stain and more likely to de-escalate therapy in GN-BSIs after susceptibilities. Although there were no significant differences in changes in antimicrobial therapy for organism identification by BCID vs traditional methods, more than one-quarter of providers (28.1%) made changes after organism identification. There were no differences in hospital length of stay or in-hospital mortality comparing pre- vs post-BCID. Conclusions Although BCID significantly reduced the time to identification for both GP-BSIs and GN-BSIs, BCID did not reduce the time to first appropriate antimicrobial escalation and de-escalation.

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