Multi-drug resistant (MDR) infections are a significant cause of morbidity, mortality, and excess cost in healthcare institutions, leading to the implementation of infection control barrier precautions geared to prevent transmission. Rapid diagnostic tests (RDT) provide prompt identification of microorganisms and resistance markers, offering a unique collaborative opportunity for both infection control and antimicrobial stewardship programs (ASPs). We evaluated the effect of RDT coupled with an ASP communication on time to placement of contact isolation in bacteremic patients with MDR organisms.
RDT was performed using Verigene® Blood Culture System (Northbrook, IL) for gram positive and gram negative microorganisms. Results were reported to the Infectious Diseases pharmacist and the corresponding practitioner caring for the patient, and an appropriate treatment regimen per protocol was selected. A retrospective chart review was performed to compare management of bacteremic patients with MDR organisms pre and post implementation of the Verigene® System. MDR was defined as acquired non-susceptibility to at least one agent in 3 or more antimicrobial classes. The primary endpoint was time to initiation of barrier precautions.
Fifty-seven patients with MDR bacteremia were included in our analysis; 25 in the pre-RDT group and 32 in the post-RDT group. The following MDR organisms were isolated from culture in the pre-RDT and post-RDT group respectively; Methicillin resistant Staphylococcus aureus (36 % vs. 47%), Vancomycin resistant Enterococcus spp. (20% vs. 3%), Extended spectrum beta-lactamase producing Enterobacteriaceae (36% vs. 25%) and Carbapenem resistant Enterobacteriaceae (8% vs. 25%). After initiation of RDT, there was a decrease in time to initiation of barrier precautions (4:14 h:min [IQR, 1:48-12:16] vs. 28:44 h:min [IQR, 4:05-49.25] p < 0.0006).
RDT coupled with an antimicrobial stewardship communication resulted in faster initiation of infection control barrier precautions, with potential implications for improved efforts to reduce the spread and transmission of healthcare associated MDR infections. Further studies are warranted to confirm these results.
K. Krevolin, None
T. Bias, None