2073. Positive Clinical Impact of MALDI-TOF for the Management of Inpatient Pneumonia Without Additional Antimicrobial Stewardship (AS) Support
Session: Poster Abstract Session: Diagnostics: Resistance Testing
Saturday, October 6, 2018
Room: S Poster Hall

Positive Clinical Impact of MALDI-TOF for the Management of Inpatient Pneumonia Without Additional Antimicrobial Stewardship (AS) Support

Background:

Matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry decreases time to identification (ID) and has been shown to improve antibiotic utilization when combined with real-time AS intervention. We assessed the impact of MALDI-TOF without additional AS support in patients with inpatient pneumonia.

Methods:

This was a single-center quasi-experimental study of adult patients with a pneumonia who had a positive respiratory culture with bacteria that were identified by MALDI-TOF from August 2016–February 2017 (Pre-MALDI-TOF) and August-February 2018 (Post-MALDI-TOF). The primary endpoint was the time to initiation of optimal therapy before and after MALDI-TOF. The secondary endpoints included: clinical cure at 7 days; inpatient antibiotic duration; infection-related length of stay (LOS); overall LOS; excess antibiotic days; and costs. T-tests, Mann Whitney U, and Chi-squared tests were used for comparisons where appropriate.

Results:

Table 1: Time to Optimal Therapy and Intervention Opportunities

Pre-

MALDI-TOF

(180)

Post-

MALDI-TOF

(180)

p-value

Total Opportunities for Interventions, n(%)

152 (84)

168 (93)

0.007

De-escalation performed, n/N(%)

105/152 (69)

124/152 (74)

0.40

Escalation performed, n/N(%)

29/152 (19)

34/152 (20)

0.79

Time to Identification, h, median, IQR

63 [46-72]

32 [24 – 46]

<0.001

Time to Optimal Therapy, h, median, IQR

73 [55-89]

56 [48 - 73]

< 0.001

Excess Doses

0 [0-1]

1 [0-3]

0.003

Excess Cost

2,122.57

3,335.72

0.007

Table 2: Outcomes

Pre-

MALDI-TOF

Post-

MALDI-TOF

p-value

In-Hospital Mortality

7 (4)

8 (4)

0.79

Inpatient Duration of Antibiotics, days, median, IQR

7 [5-10]

7 [5-9]

1

Infection Related LOS, days, median, IQR

7 [5-11]

7 [5-9]

0.09

Overall Hospital LOS, days, median, IQR

14.5 [7-32]

13 [6-29]

0.26

Clinical Cure

145 (81)

150 (83)

0.49

Conclusion:

The implementation of MALDI-TOF without AS support for pneumonia patients reduced the time to ID and optimal therapy but there were no significant differences in clinical outcomes. It did not positively impact excess antibiotic doses or costs.


Ann Marie Porreca, PharmD, BCPS1, Jason Gallagher, PharmD, FCCP, FIDSA, BCPS1 and Kaede Ota Sullivan, MD2, (1)Temple University School of Pharmacy, Philadelphia, PA, (2)Lewis Katz School of Medicine at Temple University, Philadelphia, PA

Disclosures:

A. M. Porreca, None

J. Gallagher, Achaogen: Consultant , Consulting fee . Merck: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee and Research grant . Allergan: Consultant and Speaker's Bureau , Consulting fee . Astellas: Consultant and Speaker's Bureau , Consulting fee . Cempra: Consultant , Consulting fee . Cidara: Consultant , Consulting fee . CutisPharma: Consultant , Consulting fee . Paratek: Consultant , Consulting fee . Shionogi: Consultant , Consulting fee . Tetraphase: Consultant , Consulting fee . Theravance: Consultant , Consulting fee . The Medicines Company: Consultant , Consulting fee . Melinta: Speaker's Bureau , Consulting fee .

K. Ota Sullivan, None

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