1123. Impact of the Multiplex Polymerase Chain Reaction on Appropriate Antibiotic Use in Patients with Staphylococcal Bacteremia
Session: Poster Abstract Session: MRSA/VRE Epidemiology
Friday, October 9, 2015
Room: Poster Hall

Background: Rapid identification of the responsible microorganisms in patients with bacteremia may be useful in selecting the appropriate antibiotics and discontinuing unnecessary broad spectrum antibiotics. The aim of this study was to evaluate the impact of the multiplex polymerase chain reaction (PCR) method for rapid identification of gram positive cocci cluster (GPCC) in blood cultures on the appropriate use of antibiotics in our clinical setting.

Methods: We retrospectively reviewed the medical records of patients whose blood culture grew GPCC from January, 2010 to December, 2013. Because multiplex PCR was introduced in February 2012, we divided the Staphylococcus aureus bacteremia (SAB) cases into a pre-PCR group (January 2010-December 2011) and a post-PCR group (February 2012-December 2013). Times of administration and discontinuation of antibiotics were compared in the pre-PCR and post-PCR groups.

Results: A total 1,234 episodes of GPCC bacteremia were included for analysis; 664 in the pre-PCR group and 570 in the post-PCR group. In methicillin susceptible S. aureus (MSSA) bacteremia cases, optimal antibiotics were initiated earlier in the post-PCR group (77.4 h vs 42.6 h, p=0.035). The frequency of use of empirical glycopeptide was similar in the two groups (54.7% vs 56.7%, p=0.799), but the duration of glycopeptide exposure was significantly lower in the post-PCR group (69.6 h vs 30.7 h, p=0.004). In methicillin resistant S. aureus (MRSA) bacteremia cases, the time of initiation of optimal antibiotics was similar in the two groups (45.4 h vs 43.7 h, p=0.275). In coagulase negative staphylococci (CoNS) contamination cases, the duration of glycopeptide exposure was shorter in the post-PCR cases, but the effect was statistically insignificant (137.0 h vs 120.6 h, p=0.739).

Conclusion: Introduction of the multiplex PCR test significantly improved the time to initiation of optimal antibiotics and the duration of unnecessary glycopeptide exposure in MSSA bacteremia.


Figure 1 (a) Comparison of start times of optimal antibiotic treatment in MSSA bacteremia

Figure 1 (b) Comparison of start times of optimal antibiotic treatment in MRSA bacteremia

Sun Hee Na, MD1,2, Chung-Jong Kim, MD1,2, Eun Young Nam, MD2, Eun Jung Kim, MD2, Hong Sang Oh, MD, MPH2, Moonsuk Kim, MD1, Jeong Su Park, MD3, Kyoung-Ho Song, MD1,2, Pyoeng Gyun Choe, MD2, Wan Beom Park, MD, PhD2, Ji-Hwan Bang, MD2, Eu Suk Kim, MD1,2, Sang-Won Park, MD, PhD2, Kyoung Un Park, MD, PhD3, Nam-Joong Kim, MD, PhD2, Myoung-Don Oh, MD, PhD2 and Hong Bin Kim, MD, PhD1,2, (1)Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea, (2)Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea, (3)Departments of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea

Disclosures:

S. H. Na, None

C. J. Kim, None

E. Y. Nam, None

E. J. Kim, None

H. S. Oh, None

M. Kim, None

J. S. Park, None

K. H. Song, None

P. G. Choe, None

W. B. Park, None

J. H. Bang, None

E. S. Kim, None

S. W. Park, None

K. U. Park, None

N. J. Kim, None

M. D. Oh, None

H. B. Kim, None

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