1873. MALDI-TOF alone versus MALDI-TOF combined with real-time antimicrobial stewardship interventions on time to optimal antimicrobial therapy in patients with positive blood cultures
Session: Poster Abstract Session: Antibiotic Stewardship: Diagnostics
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • MALDI alone vs MALDI plus AMS Poster.pdf (598.0 kB)
  • Background: Matrix-assisted laser desorption ionization time of flight (MALDI-TOF) decreases time to organism identification and when combined with antimicrobial stewardship interventions, has demonstrated improved clinical and financial outcomes. The purpose of this study was to evaluate the impact of MALDI-TOF alone vs MALDI-TOF combined with real-time, pharmacist-driven, antimicrobial stewardship (AMS) interventions on antimicrobial therapy-associated and patient outcomes.

    Methods: This single-center, pre-post quasi-experimental study evaluated hospitalized patients with positive blood cultures identified via MALDI-TOF combined with prospective AMS intervention (November 2015-January 2016) compared to a control cohort with MALDI-TOF identification and no active AMS intervention (November 2014-January 2015). AMS intervention included: comprehensive blood culture guideline development, real-time MALDI-TOF pharmacist notification, and prospective AMS provider feedback. The primary outcome was time to optimal antimicrobial therapy (TTOT).

    Results: A total of 252 blood cultures were included in the final analysis: 126 in each group. MALDI-TOF + AMS intervention significantly reduced overall TTOT (75.2 vs 43.1 h, p <0.001), Gram + contaminant TTOT (48.2 vs 11.8 h, p <0.001), Gram - infection (GNI) TTOT (71.8 vs 35.9 h, p <0.001), improved Gram + infection (GPI) TTOT (64.0 vs 41.6 h, p 0.082), and reduced overall hospital LOS (15.0 vs 9.0 days, p 0.021). For GPI: reduced hospital LOS (14.6 vs 10.3 days, p 0.002) and length of antimicrobial therapy 24.3 vs 18.9 days, p 0.018). For GNI: reduced time to microbiologic clearance (51.1 vs 34.5 h, p <0.001), hospital LOS (15.4 vs 7.9 days, p 0.027), and ICU LOS (5.5 vs 1.2 days, p 0.035).

    Conclusion: In order to achieve optimal outcomes, rapid identification with MALDI-TOF alone is not as impactful as MALDI-TOF combined with real-time AMS interventions.

    Maya Beganovic, Pharm.D., MPH and Sarah M. Wieczorkiewicz, Pharm.D., BCPS (AQ-ID), Pharmacy, Advocate Lutheran General Hospital, Park Ridge, IL

    Disclosures:

    M. Beganovic, None

    S. M. Wieczorkiewicz, 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.