Methods: A retrospective quasi-experimental study was conducted evaluating adult inpatients with a blood culture positive for GPC in clusters. The primary outcome of this study was to compare the time to appropriate therapy for Staphylococcal bacteremia in the pre-RDT group (January 1 – June 30, 2016) vs. post-RDT group (January 1 – June 30, 2017). Secondary endpoints included comparing the number of anti-MRSA doses administered to patients whose cultures grew coagulase-negative staphylococcus (CoNS) determined contaminants and length of stay (LOS) between groups.
Results: 252 patients were included in the study (pre-RDT n=143, post-RDT n=109). There were 58 patients with Staphylococcus aureus bacteremia (SAB) and 194 patients with CoNS. Mean time to active therapy for SAB following Gram-stain result was similar between groups (pre-RDT 4.1 hr vs post-RDT 1.06 hr, p=0.157). The median time to discontinuation of antibiotics for CoNS contaminants was significantly decreased in the post-RDT group (26.38 vs 8.27 hr, p=0.006) and the median number of anti-MRSA doses was also significantly decreased (1 vs 0 dose, p=0.003). In the post-RDT group, significantly fewer patients with CoNS cultures had empiric anti-MRSA therapy ordered after Gram-stain (50% vs 24.4%, p=0.042). Mean LOS was significantly shorter for patients with CoNS contaminants in the post-RDT group (10.1 vs 7.5 days, p=0.036).
Conclusion: Implementation of the RDT without AST notification significantly improved time to de-escalation, decreased empiric anti-MRSA antibiotic exposure, and resulted in significantly shorter LOS for patients with CoNS contaminated blood cultures.
J. Jacoby, None
A. Jameson, None
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