1015. Impact of Infectious Disease Fellow Consultative Intervention Combined with a Rapid Gram-Positive Blood Culture Microarray on Outcomes for Patients with Enterococcal Bloodstream Infection
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
Background: Decreasing the time to definitive antimicrobials for enterococcal bloodstream infections (E-BSI) will reduce exposure to unnecessary antibiotics. The Verigene Gram-Positive Blood Culture Test (BC-GP) provides identification and major resistance markers for Enterococus faecium and E. faecalis in 2.5 hours following blood culture growth, but is costly may not provide benefit. Here we evaluate the impact of a real-time Infectious Disease (ID) fellow consultative intervention in combination with BC-GP on therapy and patient outcomes.

Methods: This study took place at a University Hospital with high rates of vancomycin-resistant E. faecium (VRE) and vancomycin/ampicillin-susceptible E. faecalis (VASE). By retrospective review of charts over 3 years we compared management of E-BSI before implementation of BC-GP (batched PNA FISH), after implementation of BC-GP alone (BC-GP), and after the addition of ID consultation (BC-GP + ID). Definitive antibiotics were considered the antimicrobial selected once cultures were finalized. The primary outcome was time to definitive antibiotics. Mortality and length of stay were also evaluated. Data were analyzed with Chi-squared and Kaplan-Meier survival tests.

Results: 110 patients (63 PNA-FISH, 14 BC-GP and 33 BC-GP + ID) were evaluated. 91 patients were excluded. 52 exclusions were due to polymicrobial BSI. For patients with E. faecium BSI the mean time in hours to definitive antibiotics was 15.3 in the PNA-FISH group, 7.4 in the BC-GP group, and 2.2 in the BC-GP group (p = <0.0005). For patients with E. faecalis BSI there was no significant change in the time to definitive antibiotic therapy (PNA-FISH 13.7, BC-GP 17.3, BC-GP+ID 24.1). Length of stay was significantly reduced for E-BSI from a mean of 22 days in the PNA-FISH and BC-GP groups to 13 days in the BC-GP+ID group (p= 0.017). There was no significant difference in mortality among groups.

Conclusion: The use of BC-GP with consultative intervention from ID fellows is associated with a significant decrease in time to definitive antibiotic therapy for patients with E. faecium (mainly VRE) but not E. faecalis (mainly VASE) BSI. Length of stay for patients with E-BSI decreased after implementation of BC-GP with ID involvement but mortality did not change.

Megan Gray, MD, Heather Cox Hall, PharmD, Melinda Poulter, PhD, Joshua Eby, MD and Amy Mathers, MD, University of Virginia Medical Center, Charlottesville, VA


M. Gray, None

H. Cox Hall, None

M. Poulter, None

J. Eby, None

A. Mathers, None

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