1006. Time from Specimen Collection to Culture and Susceptibility Report Completion for Staphylococcus aureus: An Opportunity for Healthcare Quality Improvement
Session: Poster Abstract Session: Detecting, Identifying, and Typing Bacteria
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • 1006_AislingCaffrey.pdf (612.7 kB)
  • Background: A central component of antimicrobial stewardship is the timely reporting of culture and antibiotic susceptibility results so that clinicians can select appropriate treatments. Non-culture based molecular determinants of antibiotic resistance genes are now commercially available and could be used to aid in this process, with the potential to improve clinical outcomes.

    Methods: Staphylococcus aureus culture and susceptibility results (methicillin susceptible [MSSA] and resistant [MRSA]), were evaluated in five acute care facilities of the Veterans Affairs New England Healthcare System. Using specimens collected from January 2003 through December 2010, we calculated the time between the collection date and the bacterial report completion date. Time trends were analyzed with Spearman correlation and culture site differences with Wilcoxon rank-sum tests.

    Results: Time to culture report completion from collection (Table 1) differed significantly between MSSA and MRSA (p<0.0001). Results availability was shortest for urine specimens, which varied significantly from all other culture sites (p<0.0001). Non-significant decreases in reporting time were observed over the study period.

    Table 1: Time to culture and susceptibility report completion

    S. aureus

    Culture Site

    N

    Median Days (Interquartile Range)

    Mean Days       (Standard Deviation)

    MSSA

     

    7,455

    3 (3-4)

    3.8 (1.7)

     

    Blood

    567

    4 (3-6)

    4.4 (1.7)

     

    Bone

    170

    5 (3-7)

    5.0 (2.3)

     

    Lung

    1,190

    3 (3-4)

    3.5 (1.4)

     

    Skin & soft tissue

    4,210

    3 (3-5)

    3.8 (1.8)

     

    Urine

    974

    3 (2-4)

    3.3 (1.6)

     

    Other / unknown

    344

    3 (3-5)

    4.0 (1.8)

    MRSA

     

    10,275

    3 (3-4)

    3.7 (1.7)

     

    Blood

    855

    4 (3-6)

    4.6 (1.9)

     

    Bone

    211

    4 (3-6)

    4.7 (2.1)

     

    Lung

    3,153

    3 (2-4)

    3.4 (1.5)

     

    Skin & soft tissue

    3,960

    3 (3-4)

    3.8 (1.8)

     

    Urine

    1,721

    3 (2-4)

    3.3 (1.4)

     

    Other / unknown

    375

    3 (3-5)

    4.0 (1.8)

    Conclusion: The median time to bacterial report completion from collection ranged from 3 to 5 days. Alternative diagnostic modalities are needed to reduce the length of empiric therapy which in turn promotes the switch to organism-targeted therapy. Rapid molecular diagnostic testing in the microbiology laboratory could substantially improve timelines and subsequently facilitate de-escalation of antimicrobial therapy, enhance antimicrobial stewardship, and decrease length of stay.


    Subject Category: D. Diagnostic microbiology

    Aisling Caffrey, MS, PhD1,2, Stephen Brecher, PhD3,4 and Kerry LaPlante, PharmD1,2,5, (1)Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, (2)College of Pharmacy, University of Rhode Island, Kingston, RI, (3)Microbiology, Veterans Affairs Boston Healthcare System, West Roxbury, MA, (4)Boston University School of Medicine, Boston, MA, (5)Alpert Medical School of Brown University, Providence, RI

    Disclosures:

    A. Caffrey, Pfizer: Investigator, Research support

    S. Brecher, Astellas: Speaker's Bureau, Speaker honorarium
    Cubist: Speaker's Bureau, Speaker honorarium
    Forest: Speaker's Bureau, Speaker honorarium

    K. LaPlante, Pfizer: Grant Investigator, Research grant
    Cubist: Consultant, Grant Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium
    Forest: Scientific Advisor, Consulting fee
    Ortho-McNeil: Consultant, Consulting fee
    Astellas: Grant Investigator, Research grant

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