1884. Collaboration between an Antimicrobial Stewardship Team and the Microbiology Laboratory can shorten time to Directed Antibiotic Therapy
Session: Poster Abstract Session: Antibiotic Stewardship: Diagnostics
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • IDweek Staph Poster 2016 Final.pdf (513.1 kB)
  • Background: Patients with gram positive cocci in clusters (GPC) in single positive blood cultures are at increased potential risk for severe and life threatening infection and are often treated empirically with vancomycin until methicillin-resistant S. aureus (MRSA) can be excluded. Rapid identification (rID) may limit exposure to unnecessary or inappropriate antibiotics. We documented that implementation of real-time PCR at our institution led to a marked decrease in the time to ID for Staphylococcus species (SS). Rapid reporting alone, however, did not result in a decreased time to directed therapy (TDT). The goal of this study was to determine whether an intervention with an antimicrobial stewardship rapid response team (ASRT) would be effective in decreasing TDT.

    Methods:We conducted a retrospective, before-and-after, observational cohort study of blood culture reporting at a tertiary care, academic medical center from 02/2014-03/2016. All inpatients with a positive blood culture showing GPC on gram stain were included.

    In the pre-ASRT period, following the telephoned report of the gram stain, final ID and susceptibility results were reported in the electronic medical record (EMR) within 48 hrs. The laboratory then introduced direct susceptibility testing (INT1) which was later replaced by PCR (INT2) which distinguished MSSA, MRSA, and GPC which were not SA (CONS).

    In the current Intervention (INT3), PCR results were reported to the ASRT, who contacted providers directly with results and recommendations. Chart review via EMR was performed. Time of gram stain, PCR, and antibiotic change or cessation was recorded. TDT was calculated and was compared with baseline (BL), INT2, and INT3.

    Results: rID of SS by PCR resulted in an average time to ID of 3.1 hours at INT3 compared to 48 hrs at BL. Reporting of PCR by ASRT decreased the TDT from 48 hrs at BL to 42 hrs after INT2 to 20 hrs after INT3 for MSSA. For CONS, TDT with ASRT decreased from 50 hrs at BL to 47 hrs after INT2 to 24 hours after INT3.

    Conclusion: The use of rapid PCR and conventional reporting in the EMR reduced time to ID but did not translate to earlier TDT, which only occurred when there was an intervention by the ASRT. Our results suggest that TDT can be improved by modification of reporting methods and utilization of an ASRT.

    Tanaya Bhowmick, MD1, Frances Hetherington, MD1, Navaneeth Narayanan, PharmD2, Julia Cornett, MD1, Vincent Mcauliffe, MD3, Thomas Kirn, MD, PhD4 and Melvin Weinstein, MD4, (1)Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, (2)Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, (3)Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, (4)Medicine and Pathology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ

    Disclosures:

    T. Bhowmick, None

    F. Hetherington, None

    N. Narayanan, None

    J. Cornett, None

    V. Mcauliffe, None

    T. Kirn, Accelerate Diagnostics: Scientific Advisor , Speaker honorarium

    M. Weinstein, 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.