1808. Matrix-Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF) and Vitek 2 along with Antimicrobial Stewardship (ASP) Result in Faster Antimicrobial Therapy for Infected Patients: The CHI Health Experience
Session: Poster Abstract Session: Antimicrobial Stewardship: Impact of New Diagnostics
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • MALDI-poster.pdf (1.3 MB)
  • Background: Rapid organism identification (ID) and antimicrobial susceptibility testing (AST) are critical to treatment of infected patients. We sought to capture time between specimens collected for bacterial culture and appropriate therapy for patients, along with other pertinent patient management data from 2017 (without MALDI-TOF/Vitek 2 and ASP) and 2018 (with MALDI-TOF/Vitek 2 and ASP).

    Methods: Patients were eligible if admitted to CHI Health in March or April 2018 either with positive sputum, blood, or urine culture. Patients were retrospectively obtained from the Microbiology Laboratory for March 2017 and sequential patients with positive culture were reviewed. A total of 75 patients from each year (25 positive blood cultures, 25 urine cultures, 25 sputum cultures), respectively were compared. A time-in-motion study was performed to compare time to identification (ID), AST results and acted upon by ASP. Data were entered into SPSS (ver 25) for analysis. Results are reported as mean (± SD) or percentage.

    Results: Mean patient age and Charlson comorbidity index was not significantly different between 2017 and 2018. Time to obtain culture, delivery to Microbiology, and Gram-stain was not different between the two groups. Time to organism ID was significantly faster in 2018 (2018 25.2 ± 13.7, 2017 34.2 ± 17h, p=0.001). Time to AST results was also significantly faster for patients in 2018 compared to 2017 (19.8 ± 14.1 compared to 28.5 ± 15.1 h, p=0.001). ASP recommended significantly more adjustments to empiric antimicrobial therapy (25% of 2018 vs. 1% in 2017, p< 0.001). In addition, length of hospital stay was significantly shorter for patients in 2018 compared to 2017 (2018 8.3 ± 7 days and 2017 15.6 ± 18.3 days, p<0.001). Finally, in-hospital length of antimicrobial therapy was significantly shorter in 2018 compared to 2017 (2018 6.6 ± 3.7 days, 2017 8.8 ± 7.7 days, p< 0.05).

    Conclusion: Use of MALDI-TOF/Vitek 2 leads to an average 18 h faster microbial ID and AST results. ASP is able to make recommendations for infectious diseases management more appropriately with quicker ID and AST results.

    Stephen Cavalieri, PhD1, Seunghyug Kwon, MD1, Renuga Vivekanandan, MD2, Sumaya Ased, PharmD3, Cassara Carroll, PharmD3, David Schmidt, PharmD4 and Christopher Destache, PharmD5, (1)Pathology, CHI Health, Omaha, NE, (2)Medicine, Creighton University School of Medicine, Omaha, NE, (3)CHI Health, Pharmacy, Omaha, NE, (4)Pharmacy, CHI Health, Omaha, NE, (5)Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE

    Disclosures:

    S. Cavalieri, None

    S. Kwon, None

    R. Vivekanandan, None

    S. Ased, None

    C. Carroll, None

    D. Schmidt, None

    C. Destache, None

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