1485. Antimicrobial Stewardship and Rapid Diagnostic Testing Bundle for Local Management of Gram-Negative Bloodstream Infections
Session: Poster Abstract Session: Antimicrobial Stewardship: Role of Diagnostics
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • IDWeek Poster 1485 Final.pdf (527.9 kB)
  • Background: Appropriate empirical antimicrobial therapy is associated with improved outcomes of patients with gram-negative bloodstream infections (GN BSI). However, excessive use of broad-spectrum antimicrobials is not without major adverse events. This quasi-experimental cohort study evaluated the combined impact of antimicrobial stewardship interventions and rapid diagnostic testing on adequacy of empirical therapy for GN BSI and utilization of broad-spectrum antimicrobials.

    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.

    Elizabeth Nimmich, MD1, Thomas Smith III, MD2, Julie Ann Justo, PharmD, MS, BCPS, AAHIVP3, P. Brandon Bookstaver, PharmD, FCCP, BCPS (AQ-ID), AAHIVP3, Katie Hammer, PharmD4, Joseph Kohn, PharmD, BCPS5, Helmut Albrecht, MD6 and Majdi Al-Hasan, MD6, (1)University of South Carolina School of Medicine-Palmetto Health Richland, Columbia, SC, (2)University of South Carolina School of Medicine, Columbia, SC, (3)Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, (4)Carolinas Healthcare System, Charlotte, NC, (5)Palmetto Health Richland, Columbia, SC, (6)Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, SC

    Disclosures:

    E. Nimmich, None

    T. Smith III, None

    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

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.