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164
Lessons Learned from Early Implementation of Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-ToF MS) with Antimicrobial Stewardship, A Pilot Study

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Our goal was to describe early implementation of Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI) identification coupled with antimicrobial stewardship program (ASP) on timing, process and outcome in bacteremic patients.

MethodsMALDI at Montefiore received NYS Department of Health lab approval Jan. ’14.  A pilot for MALDI identification (IDENT) of blood cultures coupled with ASP notification (MALDI-IDENTASP) was compared to a matched month of conventional IDENT (CON-IDENT) (Mar. ’14 vs. ’13) to assess feasibility and resources needed. MALDI lists were e-faxed 2-3 times/day to ASP staff who reviewed medical records for demographics, antibiotic prescribing, and timing parameters. Data collection is ongoing for statistical and program evaluation (i.e. outcomes, severity adjustment) and for pediatrics.

Results: Blood cultures from 115 patients are summarized in Table 1. In Mar. ’14 >90% blood isolates were IDENT by MALDI, the majority from plates (68%) vs. bottles (32%). The median time in hours to IDENT was sooner with MALDI.  A trend towards earlier targeted antibiotics was also seen with MALDI-IDENT, especially for gram-negative rods (55.9 vs. 85.0) and isolates identified directly from bottles (64.9 vs. 77.6). These interventions required 6-10 hours daily from lab and ASP.

Table 1

MALDI-IDENT + ASP

March.’14 (n=62)

CON-IDENT

Mar.’13 (n=53)

p-value

Patient Demographics

 

 

 

     Age (mean years, range)

62 (25-94)

68 (24-93)

 

     Gender (% female)

40

57

 

     Clinical source (Top 3)

Urine (13), Abdominal (10), Bone/Joint/SSTI (9)

Urine (13), Pneumonia (10), Bone/Joint/SSTI (8)

 

     Sepsis (Sp) + Severe Sp/shock (%)

40

39

 

Pathogen distribution

 

 

 

     Gram negative (n=total)

28

34

 

     Gram positive (n=total, S.aureus, other)

47, 17, 30

32, 8, 24

 

Timing parameters (median hours, range)

 

 

 

     ATime to IDENT

31.4 (17.1-218.2)

52.2 (26.5-254.3)

<0.001

     BTime to Antibiotic Regimen

67.5 (19.4-185.8)

79.2 (33.5-241.6)

0.07

A= Microbiological identification – time collected; B= Preferred narrowest antibiotics – time collected

Conclusion: Our preliminary results suggest shortened time to identification and tailored antibiotics.  However additional data is needed for formal evaluation.  Our pilot supports that MALDI can feasibly be adapted to a large urban academic center, with proper resources and close coordination between lab and ASP staff.

Connie Park, MD1, Wendy Szymczak, PhD, MT2, Iona Munjal, MD3, Michael Levi, ScD, (D) ABMM2, Phillip Gialanella, MS2, Yi Guo, PharmD4, Julie E. Williamson, PharmD4, Philip Chung, PharmD, MS4, Rafael Ruiz, PhD, ScM5, Priya Nori, MD1 and Belinda Ostrowsky, MD, MPH1, (1)Medicine, Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, (2)Microbiology, Montefiore Medical Center, Bronx, NY, (3)Pediatrics, Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, (4)Pharmacy, Montefiore Medical Center, Bronx, NY, (5)Network Performance Group, Montefiore Medical Center, Bronx, NY

Disclosures:

C. Park, None

W. Szymczak, None

I. Munjal, None

M. Levi, None

P. Gialanella, None

Y. Guo, None

J. E. Williamson, None

P. Chung, None

R. Ruiz, None

P. Nori, None

B. Ostrowsky, None

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