1941. Impact of Clinical Pharmacist Intervention on the Effectiveness of a Rapid Diagnostic Test for Gram-Positive Bacteremia
Session: Poster Abstract Session: Antibiotic Stewardship: Pharmacist Led Interventions
Saturday, October 29, 2016
Room: Poster Hall
Background: Rapid diagnostic tests combined with antimicrobial stewardship practitioner involvement for bloodstream infections shorten the time to appropriate antibiotic initiation. We aimed to explore the independent impact of clinical pharmacist intervention on time to effective and optimal antibiotic therapies in a setting already using the Nanosphere Verigene Gram-Positive Blood Culture (BC-GP) rapid diagnostic test.

Methods: This study was performed at a 500-bed academic hospital. During the intervention period (Jan 1 – Jun 30, 2014) BC-GP results were reported to clinical pharmacists (24 hours per day, 7 days per week). During the baseline period (Jan 1 – Jun 30, 2013), results were reported to ordering providers. Effective and optimal therapies were respectively defined as any antibiotic deemed susceptible per microbiology report, and targeted antimicrobial therapy (i.e. de-escalation). The impact of the intervention on the hazards of time to optimal and time to effective therapy was analyzed using Cox proportional hazards models. There were 2 observation times: time from blood draw to test result, and time from test result to the onset of either optimal or effective therapy.

Results: 244 patients were analyzed: 134 in the baseline group and 110 in the intervention group. The hazard to achieve optimal therapy in the intervention group was 1.5 times the baseline group (95%CI 1.1-2.0; p=0.007). The effect was observed during the time from test result to onset of optimal therapy (intervention: 0.9 days, baseline: 2.0 days). To the contrary, time to reach effective therapy was longer in the intervention group, with the effect observed solely during the time from test result to onset of effective therapy (intervention: 1.4 days, baseline: 0.5 days). As expected, the time from blood draw to test result was not different between groups.

Conclusion:  Clinical pharmacist intervention had a significant impact on time to optimal therapy when a rapid diagnostic test was used to identify gram-positive bacteremia.

Sara Revolinski, PharmD, BCPS1, J Njeri Wainaina, MD1, Angela Huang, PharmD, BCPS-AQ ID1, Mary Beth Graham, MD, FIDSA2, Nathan Ledeboer, PhD, D(ABMM)3, William Peppard, PharmD, BCPS4, Sergey Tarima, PhD5 and L. Silvia Munoz-Price, MD, PhD6, (1)Froedtert & the Medical College of Wisconsin, Milwaukee, WI, (2)Medical College of Wisconsin, Milwaukee, WI, (3)Microbiology, Medical College of Wisconsin, Milwaukee, WI, (4)Pharmacy Department, Froedtert Memorial Lutheran Hospital, Milwaukee, WI, (5)Institute for Health and Society, Medical College of Wisconsin Health Research Center, Wauwatosa, WI, (6)Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI

Disclosures:

S. Revolinski, None

J. N. Wainaina, None

A. Huang, None

M. B. Graham, None

N. Ledeboer, Nanosphere: Consultant , Consulting fee

W. Peppard, None

S. Tarima, None

L. S. Munoz-Price, None

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