Incorporation of rapid diagnostic tests to improve time to antimicrobial therapy for gram-positive bacteremia and candidemia

Autor:	Katherine K. Perez, Leroy Koh, Oyejoke Fasoranti, Gordana Jasmak, Charles Janak, Punit J. Shah, Aileen Korulla
Rok vydání:	2020
Předmět:	Adult Male Microbiological Techniques medicine.medical_specialty Bacteremia Hospitals Community Time-to-Treatment 03 medical and health sciences 0302 clinical medicine Anti-Infective Agents Internal medicine medicine Humans 030212 general & internal medicine Aged Aged 80 and over Pharmacology 0303 health sciences Rapid diagnostic test biology 030306 microbiology business.industry Health Policy Hazard ratio Candidemia Length of Stay Middle Aged medicine.disease biology.organism_classification Antimicrobial Confidence interval Community hospital Cohort Female Pharmacy Service Hospital business Enterococcus faecium
Zdroj:	American Journal of Health-System Pharmacy. 77:622-631
ISSN:	1535-2900 1079-2082
DOI:	10.1093/ajhp/zxaa030
Popis:	Purpose Even with rapid diagnostic technology to swiftly identify infectious organisms, prompt response is needed to translate results into appropriate actions. The purpose of this study was to determine if the introduction of real-time pharmacist response to positive rapid diagnostic test results would decrease time to antimicrobial therapy for gram-positive bacteremia and candidemia in a community hospital setting. Methods A quasi-experimental study was conducted in 2 community hospitals. The study comprised 2 cohorts of adult patients who tested positive for gram-positive bacteremia involving Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, or Candida species. The preintervention cohort consisted of patients admitted from November 2017 through May 2018. The intervention cohort consisted of patients admitted from July 2018 through January 2019, after the intervention went live. The primary outcomes were time to optimal antimicrobial therapy and time to effective antimicrobial therapy. Results A total of 140 patients were included in the preintervention group, with 124 patients included in the intervention group. The mean (SD) time to effective therapy decreased from 13.9 (21.6) hours in the preintervention group to 8.6 (12.5) hours in the intervention group (hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.89-1.48; P = 0.29). The mean (SD) time to optimal therapy significantly decreased from 53.7 (57.7) hours in the preintervention group to 38.4 (31.5) hours in the intervention group (HR, 1.73; 95% CI, 1.33-2.26; P < 0.001). Conclusion The introduction of real-time pharmacist response to positive rapid diagnostic test results led to a significant decrease in time to optimal antimicrobial therapy but did not significantly affect time to effective therapy. The results showed that the allocation of limited resources of a community hospital to such a stewardship program is justifiable.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5087f8392e0e33cd0c409241a71f371d https://doi.org/10.1093/ajhp/zxaa030 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
Nepřihlášeným uživatelům se plný text nezobrazuje	K zobrazení výsledku je třeba se přihlásit.