1438. Impact of Combined Antimicrobial Stewardship Interventions to Improve Treatment of Patients with Staphylococcus aureus Bloodstream Infection (SAB) at a Tertiary Care Center
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • ID Week 2015 SAB poster.pdf (508.7 kB)
  • 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

    Christina Sarubbi, PharmD1, Michael Wolcott, PharmD1, Rebekah W. Moehring, MD, MPH2, Richard H. Drew, PharmD, MS, BCPS, FCCP2, Coleen K. Cunningham, MD3, Michael J. Durkin, MD, MPH2, Shera Watson, MPH2, Lauren P. Knelson, MSPH2 and Deverick Anderson, MD, MPH, FIDSA, FSHEA2, (1)Pharmacy, Duke University Hospital, Durham, NC, (2)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (3)Pediatrics, Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, NC

    Disclosures:

    C. Sarubbi, None

    M. Wolcott, 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

    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.