687. The Implementation of Matrix-Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) and its Impact on the Antimicrobial Management of Pediatric Patients with Positive Blood Cultures
Session: Poster Abstract Session: They've Been Here a Billion Years! Pediatric Bacterial and Viral Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • MALDI-IDSA_POSTER.jpg (732.0 kB)
  • Background: The Mount Sinai Hospital clinical microbiology laboratory implemented MALDI-TOF MS directly from positive blood culture broth in February 2016. Prior to its institution, an automated biochemical method, VITEK-2, was used for organism identification and is currently still used for susceptibility testing. MALDI-TOF MS technology provides rapid, accurate identification of bacteria with improved clinical outcomes in adult studies. We hypothesize that rapid pathogen identification from positive blood cultures coupled with antimicrobial stewardship will improve clinical outcomes for pediatric patients at our institution.

    Methods: Retrospective data was collected for patients admitted to Kravis Children’s Hospital with positive blood cultures from July 1, 2014- June 30, 2015 prior to the initiation of MALDI-TOF MS technology. Prospective data following implementation of MALDI-TOF MS has been collected since February 2016 and will continue until February 2017. Clinical outcome measures recorded include time from report of a positive blood culture until organism identification and susceptibilities, the duration of broad spectrum and inappropriate antibiotics, time to effective antimicrobial treatment, patient length of stay and mortality.

    Results: There were 210 patients in our pre-intervention group and 31 patients in our post-intervention group thus far. Average time to organism identification decreased from 41 hours to 11 hours (p=0.00). Time to susceptibilities decreased from 31 hours to 27 hours (p<.33). Time to narrowing of antibiotics to optimal therapy decreased from 58 hours to 39 hours (p<0.018). Time to discontinuation of unnecessary antibiotics decreased from 49 hours to 23 hours (p<0.002). Length of stay averaged 41 days pre-intervention and thus far 22 days post-intervention but infection-related length of stay remains 9 days pre- and post-intervention (p<0.199).

    Conclusion: Interim data suggests that MALDI-TOF MS technology leads to more rapid pathogen identification which decreases the time pediatric patients are on unnecessary broad spectrum antibiotics. Its impact on length of stay, mortality, and hospital antibiotic costs will be determined as we continue to collect data through February 2017.

    Sejal Bhavsar, M.D.1, Camille Hamula, PhD2 and Tanis Dingle, Ph.D.2, (1)Pediatric Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, NY, (2)Pathology, Icahn School of Medicine at Mount Sinai, New York, NY

    Disclosures:

    S. Bhavsar, None

    C. Hamula, None

    T. Dingle, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.