1876. Clinical and Pharmaco-economical Impact of Rapid Diagnostic Technology and Antimicrobial Stewardship For Patients With Gram Positive and Gram Negative Bloodstream Infections
Session: Poster Abstract Session: Antibiotic Stewardship: Diagnostics
Saturday, October 29, 2016
Room: Poster Hall
Background: A growing emphasis has been placed on rapid diagnostics testing (RDT) for bacteremias in health systems. In current literature RDT has been limited by focus on gram-positive (GP) infections only and lack of pharmaco-economic (PE) data. The BioFire® RDT provides accurate identification and resistance gene detection of most GP and gram-negative (GN) microbes in hours; we sought to evaluate clinical outcomes and PE analysis for GP and GN bacteremias.

Methods: An IRB approved retrospective interventional study was performed at a 600 bed university health system, evaluating adult inpatients with GP and GN bacteremias (Pre-RDT) Jan to April 2014 and (Post-RDT) Jan to April 2015. The primary objective of the study was to evaluate the time from blood culture to organism identification (OI) and microbiological cure (MC). Secondary objective included impact of RDT on appropriate antimicrobial therapy, length of stay (LOS) and length of therapy (LOT) and PE analysis.

Results: There were total of 162 patients with positive blood cultures with 80 patients in pre-RDT group matched with 82 patients in post-RDT group. Mean time to OI from blood draw was much shorter in post-RDT group compared to pre-RDT group (31.4 hours vs. 57.4 hours, p=0.01), and patients in post-RDT group achieved MC faster than pre-RDT group (42.1 hours vs. 57.6 hours, p=0.03). Patients in post-RDT group had shorter time to ID consult from culture collected compared to pre-RDT (26.6 hours vs. 38.8 hours, p=0.02). Patients in post-RDT group had higher rates of escalation of therapy (17% vs. 5%, p=0.02). There was no statistical difference seen in average LOS between the groups (6.98 days vs. 7.40 days), however patients in post-RDT group had shorter LOT vs. pre-RDT group, (10.56 days vs. 13.26 days, p=0.03). Rates of MRSA, VRE and CRE were similar between the groups (5.2% vs. 4.2% vs. 1.5%) respectively. Total direct cost of therapy for post-RDT group was $905,537 compared to $974,821 in pre-RDT group, leading to cost savings of $69,284.

Conclusion: The implementation of RDT led to faster organism identification and microbiological cure. It led to increased rates of appropriate therapy and shorter time to infectious diseases consultation from blood culture draw. Post-RDT group showed significantly decreased LOT and direct cost savings.

Nikunj Vyas, PharmD, Pharmacy, Kennedy Health, Stratford, NJ, Matthew Gogoj, PharmD, Pharmacy, University of Sciences in Philadelphia, Philadelphia, PA, Cindy Hou, DO, FACOI, Infectious Diseases, Kennedy Health, Stratford, NJ, Tanvi Patel, RPh, Pharmacy, Kennedy Health - Cherry Hill Division, Cherry Hill, NJ and Deborah Cunningham, MT HHS, BA, Microbiology/Laboratory, Kennedy Health - Cherry Hill Division, Cherry HIll, NJ

Disclosures:

N. Vyas, None

M. Gogoj, None

C. Hou, None

T. Patel, None

D. Cunningham, None

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