Improving outcomes and antibiotic stewardship (IOAS) for patients with Gram-positive bloodstream infections through use of rapid testing: a quasi-experimental multicentre study of the Accelerate PhenoTest™ BC Kit
| Autor: | Dilek Ince, Romney M. Humphries, Kaleb Wolfe, Eric R Rosenbaum, Ryan K Dare, Shawn H. MacVane, Bradley Ford, Amira A. Bhalodi, Patrick M Kinn, Kelly M Percival |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty medicine.drug_class 030106 microbiology Antibiotics Bacteremia medicine.disease_cause 03 medical and health sciences Antimicrobial Stewardship 0302 clinical medicine Internal medicine medicine Antimicrobial stewardship Humans AcademicSubjects/MED00740 Pharmacology (medical) Blood culture 030212 general & internal medicine Adverse effect Original Research Pharmacology medicine.diagnostic_test business.industry Incidence (epidemiology) Acute kidney injury medicine.disease Methicillin-resistant Staphylococcus aureus Anti-Bacterial Agents Infectious Diseases AcademicSubjects/MED00290 business AcademicSubjects/MED00230 |
| Zdroj: | Journal of Antimicrobial Chemotherapy |
| ISSN: | 1460-2091 |
| Popis: | BackgroundData from the Improving Outcomes and Antibiotic Stewardship for Patients with Bloodstream Infections: Accelerate PhenoTest™ BC Kit (AXDX) Registry Study were analysed to determine the impact of rapid organism identification and antimicrobial susceptibility testing (AST) for Gram-positive bacteraemia.Patients and methodsThis multicentre, quasi-experimental study evaluated clinical and antimicrobial stewardship metrics following the implementation of AXDX. Data from hospitalized patients with bacteraemia were compared between groups, one that underwent testing on AXDX (post-AXDX) and one that underwent traditional identification and AST (pre-AXDX). An analysis of patients with Gram-positive bacteraemia was performed. The primary outcome was time to optimal therapy (TTOT). Secondary outcomes included time to first antibiotic modification (overall and Gram-positive), duration of unnecessary MRSA coverage, incidence of adverse events, length of stay and mortality.ResultsA total of 219 (109 pre-AXDX, 110 post-AXDX) patients with Gram-positive bacteraemia were included. Median TTOT was 36.3 h (IQR, 16.9–56.7) in the pre-AXDX group and 20.4 h (IQR, 7.5–36.7) in the post-AXDX group (P = 0.01). Compared with pre-AXDX, median time to first antibiotic modification (29.1 versus 15.9 h; P = 0.002), time to first Gram-positive antibiotic modification (33.2 versus 17.2 h; P = 0.003) and median duration of unnecessary MRSA coverage (58.4 versus 29.7 h; P = 0.04) were reduced post-AXDX. A trend towards decreased acute kidney injury (24% versus 13%; P = 0.06) was observed in the post-AXDX group. Groups did not differ in other secondary outcomes.ConclusionsImplementation of AXDX testing for patients with Gram-positive bacteraemia shortened the TTOT and reduced unnecessary antibiotic exposure due to faster antibiotic modifications. |
| Databáze: | OpenAIRE |
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