684. Impact of Rapid Diagnostic Testing on Antibiotic Prescribing in Hospitalized Children with Positive Blood Cultures
Session: Poster Abstract Session: They've Been Here a Billion Years! Pediatric Bacterial and Viral Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • IDWeek 2016 Poster Presentation Final.pdf (475.5 kB)
  • Background: Rapid diagnostic testing for bacteria, such as matrix assisted laser desorption ionization time of flight (MALDI-TOF) and multiplex PCR (mPCR), have been shown to decrease mortality and length of stay in adults, but the utility for optimizing antibiotic prescribing and improving clinical outcomes in children is poorly understood.

    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.

    Caroline Reuter, MD1, Rupal Patel, PharmD2, Xiaotian Zheng, MD, PhD3, Zena Leah Harris, MD4, Yusuf Chao, BA5, William Lewis, MD6, Zachary Aldewereld, MD6 and Sameer Patel, MD, MPH7, (1)Pediatric Infectious Disease, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, (2)Pediatric Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, (3)Children's Memorial Hospital, Chicago, IL, (4)Pediatric Critical Care, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, (5)Mcgaw Medical Center, Feinberg School of Medicine of Northwestern University, Chicago, IL, (6)Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, (7)Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL

    Disclosures:

    C. Reuter, None

    R. Patel, None

    X. Zheng, None

    Z. L. Harris, None

    Y. Chao, None

    W. Lewis, None

    Z. Aldewereld, None

    S. Patel, 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.