239. Understanding Physician Perceptions about the Medical Value of Tests to Diagnose Bloodstream Infections
Session: Poster Abstract Session: Diagnostic Microbiology
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Physicians historically have relied on blood culture (BC) to diagnose bloodstream infections (BSI) and now novel tests are being developed for faster detection of BSI. Yet the influence of culture-based or novel BSI tests in medical decision-making has not been well- established. We aimed to understand the value of BSI diagnostic testing by physician survey.

Methods: We surveyed infectious diseases, pulmonary/critical care, and hospitalist physicians in USA and Germany about current standards of care in diagnosing and treating BSI. The survey also included questions about a hypothetical rapid BSI test. The survey was administered in non-academic and academic settings with IRB exemption. We used univariate analysis to summarize individual results, Spearman’s rho to investigate relationships between questions, and Cronbach’s alpha to assess internal consistency of test questions.

Results: Responses from 181 physicians were obtained with roughly equal representation across specialties. For suspected BSI patients, 78% of physicians would administer empiric broad spectrum antibiotics. On average, physicians estimated that 30% of patients were treated with incorrect antibiotics while awaiting BC results and 94% believed delayed effective therapy had moderate to extremely high impact on costs. Depending on the microorganism detected, 62-87% of physicians would narrow the spectrum of antimicrobial therapy upon a rapid test result, and 80-86% would narrow/change antimicrobials when a rapid test included resistance markers. Significant correlations were found between those physicians applying the rapid test to all or high-risk patients and their belief that a rapid test would reduce antibiotic consumption, patient morbidity/mortality and intensity of healthcare utilization (all p<0.01).

Conclusion: Blood culture TAT was perceived as a barrier to care because of delay in initiating effective, targeted antimicrobial therapy. A rapid test to diagnose BSI was judged to be impactful on medical decision making, adverse patient events, and overall healthcare costs. This survey provides data on physician practices and perceptions about the value of BSI tests that may help clinicians and laboratorians with technology assessment and test adoption.

Rosemary C. She, MD1, Andrew Wilson2, Keith Simmon, MS2 and Cathy Petti, MD3, (1)Keck School of Medicine of USC, Los Angeles, CA, (2)University of Utah, Salt Lake City, UT, (3)Healthspring Global Inc, Albuquerque, NM

Disclosures:

R. C. She, None

A. Wilson, None

K. Simmon, None

C. Petti, nanoMR Inc: Consultant and Scientific Advisor, Salary
USDS Inc.: Consultant, Salary

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