Methods: We compared antibiotic prescribing for treatment of monomicrobial blood culture isolates in patients ≤21 years old at Lurie Children’s Hospital between 2012 (prior to the adoption of mPCR and MALDI-TOF for organism identification) and 2015 (after mPCR and MALDI-TOF introduced and antimicrobial stewardship program developed). For 200 consecutive isolates in each year, we reviewed rapid diagnostic and conventional microbiology reports, timing and selection of antibiotic therapy, and clinical outcomes. The primary outcome was time to optimal therapy, defined as first administration of appropriate narrow spectrum therapy or discontinuation of antibiotic therapy if the isolate was a contaminant. Secondary outcomes were time to effective therapy, clinical worsening 24-72 hours after culture collection, and 30-day mortality.
Results: In 2012, there were 131 opportunities to optimize antibiotic therapy (67 and 64 opportunities to narrow or discontinue antibiotics, respectively), and in 2015, there were 145 opportunities to optimize antibiotic therapy (75 and 70 opportunities to narrow or discontinue antibiotics, respectively). Mean time to optimal therapy (3.4 vs. 4.0 days, p=0.023) and mean time to effective therapy (3.2 vs. 8.6 hours, p=0.028) were both shorter in 2015 compared to 2012. The number of children with clinical worsening 24-72 hours after culture collection (29 vs. 22, p=0.36) and 30-day mortality (13 vs. 11, p=0.39) did not differ between 2015 and 2012, respectively. Common opportunities to optimize antibiotic therapy included discontinuing antibiotics for coagulase-negative Staphylococci, using cefazolin to treat methicillin-susceptible S. aureus infections, and using narrow spectrum beta-lactams to treat gram-negative organisms.
Conclusion: Rapid diagnostic testing in pediatric patients was associated with shorter times to optimal and effective antibiotic therapy, though the clinical impact was unclear.
X. Zheng, None
Z. L. Harris, None
Y. Chao, None
W. Lewis, None
Z. Aldewereld, None
S. Patel, None
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