Background: Positive impact of antimicrobial stewardship interventions (ASI) on antibiotic use and patient outcomes has relied on significant use of resources, like 24/7 ASI or RDT. We performed a pre-post quasi-experimental study to evaluate the impact of ASI for BSI on antibiotic use and patient outcomes.
Methods: Interventions took place from 6/15 to 10/15 at Rush University Medical Center. ASI (audit & feedback) based on institutional guidelines and available microbiologic data were performed daily (6am-3pm), at time of culture positivity and at time of final report. Historical controls from 6/14 to 10/14 were selected. Time to effective (active coverage for causative pathogen) and time to optimal (targeted to specific pathogen) therapy were measured in hours (h). ASI was performed on 164 BSI and compared to 150 BSI controls without ASI. Skin contaminants (99) were excluded except for Vancomycin duration analysis.
Results: 115 BSI were included in ASI and 100 in control. Prior to culture positivity, 74.8% of patients in ASI and 69.3% of controls were on effective therapy. Of the patients not on effective therapy at time of culture positivity, there was no difference in median time to effective therapy (ASI 9h vs control 5h, p=0.7). Most ASI recommendations were followed (94.3%). The ASI group had a significant decrease in vancomycin and anti-pseudomonal β-lactam (APBL) use, with a trend towards decreasing time to optimal therapy after culture positivity (Table 1). The percent of new infectious disease consults was decreased in the ASI group (36.6% vs 53.3%; p=0.003). There was no difference in length of stay or in-hospital mortality.
Conclusion: In our institution, most patients received effective therapy prior to blood culture positivity. Even in the absence of RDT, ASI decreased vancomycin and APBL use, with a trend towards shortening time to optimal therapy. The results suggest that in similar settings, ASI on BSI may have greater impact when focused on antibiotic de-escalation.
E. Cornejo Cisneros,
S. Wang, None
A. Simms, None
D. C. Nguyen, None
C. A. Varughese, None
A. Hanson, None
K. Singh, None
G. M. Trenholme, None
S. Won, None
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