Methods: A retrospective, observational cohort study was performed in a 433-bed tertiary care medical center. A pre-policy cohort was established among patients with microbiological evidence of gram-negative bacteremia from January-December 2014. The post-policy cohort included patients who were admitted after a blood culture PCR system and automatic ID consultation policy were implemented. The primary outcome of interest was all-cause in-hospital mortality. Secondary outcomes included overall and intensive care unit (ICU) length of stay (LOS), 30 day readmission, total cost per case, and average time to speciation.
Results: A total of 111 patients met inclusion criteria during the entire study period (69 patients in the pre-policy cohort and 42 patients in the post-policy cohort). Baseline characteristics were similar between groups. After implementing the multiplex blood culture PCR system, overall time to speciation was reduced by approximately 2 days (68.2 ± 17.6 hours vs. 19.4 ± 7.3, P < 0.001). Non-significant reductions in all-cause in-hospital mortality (11.6% vs. 7.1%, P = 0.529), overall LOS (8.5 ± 5.8 days vs. 6.9 ± 5.0 days, P = 0.145) and ICU LOS (6.8 ± 4.6 days vs. 4.4 ± 4.2 days, P = 0.122) were observed after policy implementation. Total cost per case was reduced by approximately $3,527 ($12,559 vs. $9,032, P = 0.101), but the difference was also not statistically significant.
Conclusion: Implementation of a multiplex blood culture PCR system resulted in a significant reduction in time to speciation among patients with documented gram-negative bacteremia. When combined with automatic ID consultation, reductions in all-cause in-hospital mortality, overall and ICU LOS, and total cost per case were observed, but the difference was not statistically significant. The lack of statistical significance may be attributed to small sample size or a higher incidence of extended-spectrum beta-lactamase producing organisms in the post-policy cohort.
A. R. Cowden,
G. S. King, None
K. E. Luh, None
D. M. Stephens, None
C. Kennedy, None
W. R. Judd, Biomerieux: Grant support for expansion of PCR testing , Grant recipient
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