1492. Experience with Rapid Diagnostic Technology and Antimicrobial Stewardship for Patients with Gram-positive Bloodstream Infections
Session: Poster Abstract Session: Antimicrobial Stewardship: Role of Diagnostics
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • BC-GP Verigene IDWeek 2015 Final.pdf (275.8 kB)
  • Background: Time to appropriate antimicrobial therapy has been correlated with improved patient outcomes. Rapid diagnostic technology (RDT) can detect pathogens and antimicrobial resistance genes to allow earlier initiation of appropriate therapy and faster de-escalation to more targeted therapy.  Current literature focuses on outcomes with single species of organisms; we sought to evaluate clinical outcomes for all target pathogens.

    Methods: A retrospective pre/post study at Cleveland Clinic, a 1400 bed academic medical center, evaluating adult inpatients with gram-positive blood cultures before (Feb 15-Sept 14, 2014) and after (Sept 15 – Feb 14, 2015) implementation of the RDT (Verigene® Gram-Positive Blood Culture Test) and an antimicrobial stewardship (ASP) initiative.  The ASP intervention included electronic real-time notification of positive results to infectious diseases (ID) trained pharmacists who then made recommendations on drug therapy.  Data collection included demographic, microbiological, antibiotic related information, and length of stay.

    Results: 619 patients with blood cultures with gram-positive organisms other than coagulase-negative staphylococci were screened and 513 included (300 in the pre-RDT group and 213 in the post-RDT group).  Majority of patients were on medical services (76% vs. 73%) and only 12% vs. 16% were in an ICU at time of blood culture.  The most common pathogens in both pre-RDT and post-RDT groups were S. aureus (38% vs. 45% MRSA), Enterococcus spp. (25% vs. 49% VRE), and Streptococcus spp..  Significantly more patients had an antibiotic escalation to appropriate therapy in the post-RDT group (10% vs. 16%, p=0.032) and time to appropriate therapy was improved (50.4 vs. 36 hrs, p=0.17). Time to de-escalation was significantly improved in the post-RDT group (81.6 vs. 52.8 hrs).  More patients in the post-RDT group received an ID consult (45% vs. 86%, p<0.001).  Hospital LOS was not different (21.3 vs. 24.5 days, p=0.27).

    Conclusion: RDT with antimicrobial stewardship intervention significantly decreased time to de-escalation.  The number of ID consults was also significantly increased in the post-RDT group.

    Elizabeth Neuner, PharmD1, Andrea Pallotta, Pharm.D.1, Simon Lam, PharmD1, David Stowe, RPh1, Lisa Stempak, MD2, Gary Procop, MD, FIDSA3 and Sandra S. Richter, MD, FIDSA4, (1)Pharmacy, Cleveland Clinic, Cleveland, OH, (2)Cleveland Clinic, Cleveland, OH, (3)Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH, (4)Laboratory Medicine, Cleveland Clinic, Cleveland, OH

    Disclosures:

    E. Neuner, None

    A. Pallotta, None

    S. Lam, None

    D. Stowe, None

    L. Stempak, None

    G. Procop, None

    S. S. Richter, BD diagnostics: Investigator , Research support
    OpGen: Investigator , Research support
    bioMerieux: Investigator , Research support
    Nanosphere: Investigator , Research support
    Cerexa: Investigator , Research support
    Pocared: Investigator , Research support
    Biofire: Investigator , Research support
    Achaogen: Investigator , Research support

    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.