Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Background: Prompt, appropriate therapy guided by ID consultants and improved diagnostics are evidence-based strategies to improve outcomes for patients with SAB. Strategies to decrease the time to appropriate therapy and involvement of ID consultants are needed.
Methods: We performed a retrospective 3-arm study with quasi-experimental design to evaluate the impact of two policy changes implemented by the Duke Antimicrobial Stewardship and Evaluation Team (ASET). No policies regarding the care of patients with SAB were in place from 5/2012 through 4/2013 (arm 1, control). From 5/2013 through 4/2014, all patients with SAB required automatic ID consultation (arm 2). Arm 3 of our study (from 5/2014 through 4/2015) involved the use of both rapid diagnostic testing and automatic ID consultation. Time to appropriate therapy was calculated as the difference (in days) from the time the first positive culture was drawn and the time of the first administration of the appropriate therapy.
Results: A total of 515 patients with SAB met all inclusion criteria. The proportion of patients who received ID consultation increased from 65% in Arm 1 to >96% in Arms 2 and 3 (p<0.0001). Similarly, ID consultants evaluated patients with SAB more rapidly in Arms 2 and 3 (p<0.0001). The proportion of patients with SAB who received prompt appropriate therapy was highest in Arm 3 (table 1).
Conclusion: In our large tertiary care center, the combined approach of rapid diagnostic testing and mandatory ID consultation led to more prompt and appropriate therapy and care.
Table 1. Comparison of 3 stewardship approaches to treatment of SAB at a tertiary care center
| Arm 1 N=154 n (%) | Arm 2 N=202 n (%) | Arm 3 N=159 n (%) | p-value |
Proportion who received ID consult | 100 (65) | 193 (96) | 156 (98) | <0.0001 |
Time to ID consultation (days) – median (IQR) 2 | 3 (1-4) | 2 (1-3) | 2 (1-2) | <0.0001 |
Time to appropriate therapy (hr) – median (IQR)1 | 24.5 (3-73) | 68.3 (8 -86) | 22.9 (4-42) | <0.001 |
Appropriate therapy within 48 hours of culture1 | 93 (59) | 85 (43) | 127 (80) | <0.0001 |
PCN Allergy | 35 (20) | 34 (17) | 17 (11) | 0.05 |
MRSA | 75 (44) | 77 (38) | 78 (49) | 0.11 |
In-hospital death | 20 (12) | 25 (12) | 13 (8) | 0.41 |
Length of stay – median (IQR) | 12.1 (6-23) | 12 (7-20) | 12 (7-21) | 0.84 |
1 – among patients who received appropriate therapy
2 – among patients who received an ID consultation
Disclosures:
C. Sarubbi,
None
R. W. Moehring, None
R. H. Drew, UpToDate: Contributor , Publication royalty
American Society of Microbiology: Speaker's Bureau , Speaker honorarium
CustomID: Scientific Advisor , Licensing agreement or royalty
Independent Healthcare Education: Speaker's Bureau , Speaker honorarium
C. K. Cunningham, None
M. J. Durkin, None
S. Watson, None
L. P. Knelson, None
D. Anderson, None