Molecular testing has been shown to improve turnaround time (TAT) for identifying bloodborne pathogens. Early results can inform directed escalation or de-escalation of antimicrobial therapy. Paired with antibiotic stewardship, rapid pathogen identification has been shown to reduce antibiotic utilization and improve patient outcomes. However, many of these studies were in single site institutions. We evaluated implementation of the BioFireÒ FilmArray Blood Culture Identification System (BCID) across 3 acute care facilities utilizing a central testing laboratory at Carolinas Healthcare.
BCID testing was implemented over a 2- month period. A multidisciplinary team developed standard protocols for processing, transport and testing, with communication of results across teams of stewardship pharmacists. Standard algorithms were used across all facilities to guide antibiotic prescribing. Data were collected between January and May 2017 from three sources (BacTec, Theradoc and Cerner EMR). Positive bottles were tracked from the time of the positive bottle alert through pharmacist intervention. We evaluate rates of interventions and consistency using variance comparison tests.
708 positive blood cultures were identified at 3 acute care facilities and tested using BCID. TAT from positive bottle to BCID result was 4.6 (95% CI 4.4-4.8) hrs. 86.7% (614/708) were on appropriate empiric antimicrobials at the time of the BCID result. 28.0% (198/708) required a recommendation by a pharmacist. 39.6% (78/197) had an escalation recommendation while 26.4% (52/197) had a de-escalation recommendation. There was no significant variation across shifts or sites except with de-escalation where variation was greater than 10% across sites (p=0.02).
BCID testing was successfully implemented across a large integrated healthcare system using central testing laboratory paired with a team of stewardship and virtual care pharmacists. Our strategy provided timely and reproducible results across facilities and shifts. Implementation of BCID allowed for more pathogen directed therapy at all facilities with variability in need for escalation and de-escalation of therapy between facilities.
K. Goodson, None
G. A. Capraro, None
L. McCurdy, None