Methods: Adult patients with GN BSI at Palmetto Health Hospitals in Columbia, SC were identified in the pre- (January 2010 – December 2013) and post-implementation (January 2014 - April 2015) periods. Interventions comprised of institutional management guidelines, prospective antimicrobial stewardship monitoring of GN BSI, matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) and FilmArray Blood Culture Identification Panel (BCID). Logistic regression and Kaplan-Meier analysis were used to examine adequacy of empirical therapy and duration of antimicrobial therapy, respectively.
Results: A total of 1104 patients with GN BSI were included, 830 pre- and 274 post-implementation. Post-implementation there was a decrease in utilization of combination antimicrobial therapy (13% post vs. 27% pre, p < 0.001) and anti-pseudomonal therapy (76% vs. 82%, p=0.01). Interventions were associated with increased adequacy of empirical antimicrobial therapy overall (95% vs. 91%, odds ratio [OR] 1.8, 95% confidence intervals [CI] 1.0-3.3). This finding was more profound in subgroups of BSI due to Pseudomonas aeruginosa or chromosomally-mediated AmpC-producing Enterobacteriaceae (97% vs. 87%, OR 4.1, 95% CI 1.2-26.5) and Pitt bacteremia scores ≥ 4 (98% vs. 90%, OR 6.5, 95% CI 1.3-117.4). Post-intervention, time to de-escalation off anti-pseudomonal beta-lactams (2.6 vs. 3.5 days, p < 0.001), carbapenems (2.3 vs. 3.7 days, p < 0.001), and combination therapy (1.6 vs. 2.7 days, p < 0.001) was decreased.
Conclusion: Implementation of antimicrobial stewardship and rapid diagnostic interventions was associated with improved adequacy of empirical antimicrobial therapy for GN BSI while also showing a decrease in utilization of broad-spectrum antimicrobials.
J. A. Justo, Cempra Pharmaceuticals: Scientific Advisor , Consulting fee
P. B. Bookstaver, Forest Labs: Grant Investigator and Scientific Advisor , Consulting fee
K. Hammer, None
J. Kohn, None
H. Albrecht, Gilead: Investigator and Scientific Advisor , Research grant
M. Al-Hasan, None