Implementation of a Rapid Phenotypic Susceptibility Platform for Gram-Negative Bloodstream Infections With Paired Antimicrobial Stewardship Intervention: Is the Juice Worth the Squeeze?

Autor: Robinson ED; Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health. Charlottesville, Virginia, USA., Stilwell AM; Department of Pharmacy Services, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA., Attai AE; Clinical Microbiology Laboratory, Department of Pathology, University of Virginia Health, Charlottesville, Virginia, USA., Donohue LE; Department of Pharmacy Services, University of Virginia Health, Charlottesville, Virginia, USA., Shah MD; Department of Pharmacy Services, University of Virginia Health, Charlottesville, Virginia, USA., Hill BK; Department of Pharmacy Services, University of Virginia Health, Charlottesville, Virginia, USA., Elliott ZS; Department of Pharmacy Services, University of Virginia Health, Charlottesville, Virginia, USA., Poulter M; Clinical Microbiology Laboratory, Department of Pathology, University of Virginia Health, Charlottesville, Virginia, USA., Brewster F; Clinical Microbiology Laboratory, Department of Pathology, University of Virginia Health, Charlottesville, Virginia, USA., Cox HL; Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health. Charlottesville, Virginia, USA.; Department of Pharmacy Services, University of Virginia Health, Charlottesville, Virginia, USA., Mathers AJ; Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health. Charlottesville, Virginia, USA.; Clinical Microbiology Laboratory, Department of Pathology, University of Virginia Health, Charlottesville, Virginia, USA.
Jazyk: angličtina
Zdroj: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2021 Sep 07; Vol. 73 (5), pp. 783-792.
DOI: 10.1093/cid/ciab126
Abstrakt: Background: Implementation of the Accelerate PhenoTM Gram-negative platform (RDT) paired with antimicrobial stewardship program (ASP) intervention projects to improve time to institutional-preferred antimicrobial therapy (IPT) for Gram-negative bacilli (GNB) bloodstream infections (BSIs). However, few data describe the impact of discrepant RDT results from standard of care (SOC) methods on antimicrobial prescribing.
Methods: A single-center, pre-/post-intervention study of consecutive, nonduplicate blood cultures for adult inpatients with GNB BSI following combined RDT + ASP intervention was performed. The primary outcome was time to IPT. An a priori definition of IPT was utilized to limit bias and to allow for an assessment of the impact of discrepant RDT results with the SOC reference standard.
Results: Five hundred fourteen patients (PRE 264; POST 250) were included. Median time to antimicrobial susceptibility testing (AST) results decreased 29.4 hours (P < .001) post-intervention, and median time to IPT was reduced by 21.2 hours (P < .001). Utilization (days of therapy [DOTs]/1000 days present) of broad-spectrum agents decreased (PRE 655.2 vs POST 585.8; P = .043) and narrow-spectrum beta-lactams increased (69.1 vs 141.7; P < .001). Discrepant results occurred in 69/250 (28%) post-intervention episodes, resulting in incorrect ASP recommendations in 10/69 (14%). No differences in clinical outcomes were observed.
Conclusions: While implementation of a phenotypic RDT + ASP can improve time to IPT, close coordination with Clinical Microbiology and continued ASP follow up are needed to optimize therapy. Although uncommon, the potential for erroneous ASP recommendations to de-escalate to inactive therapy following RDT results warrants further investigation.
(© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.)
Databáze: MEDLINE