342. Time to Antimicrobial De-escalation/Discontinuation After Implementation of Cerebrospinal Fluid Polymerase Chain Reaction Tool
Session: Poster Abstract Session: CNS Infections
Thursday, October 4, 2018
Room: S Poster Hall
  • ID Week Poster 2018 - CSF PCR.pdf (561.7 kB)
  • Background: Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) technology can be used as a rapid diagnostic tool that has the potential to more rapidly facilitate targeted antimicrobial therapy and reduce overall time to de-escalation and/or discontinuation of inappropriate antimicrobial usage in patients with suspected meningitis/encephalitis.

    Methods: This was a single-center, retrospective cohort analysis with a primary objective focusing on time to de-escalation or discontinuation of inappropriate antimicrobials before and after implementation of a rapid diagnostic meningitis/encephalitis (ME) panel (BioFire FilmArray®). The pre-implementation group, containing 84 patients, examined individuals who had CSF cultures performed in the 6-months prior to implementation. The post-implementation group, containing 88 patients, examined individuals who had an ME panel done in the 6 months following a transitionary 1-month period following implementation. Categorical data analysis was performed using Chi-squared or Fisher's Exact test and continuous data was analyzed using the Mann-Whitney U test.

    Results: Time to de-escalation/discontinuation of inappropriate ampicillin reported in median hours (IQR) was 47.5 (55) for pre-PCR group compared to 39.5 (23.5) in post-PCR group (p=0.004). Time to de-escalation/discontinuation of Cefotaxime for pre-PCR group was 50.5 (42) compared to 45 (10) for post-PCR (p=0.027). Using a subgroup analysis based on age, the results for ampicillin and cefotaxime were mirrored in the pediatric population, however, results were insignificant in the adult population. Subgroup analysis of the adult population showed significance in terms of de-escalation/discontinuation of acyclovir reported (in median hours) as 49 (68) in pre-PCR and 19 (18) in post-PCR group (p=0.002).

    Conclusion: Time to de-escalation and/or discontinuation of ampicillin and cefotaxime was significantly reduced after implementation of the ME panel suggesting clinical significance in high-risk populations such as neonates. Time to de-escalation and/or discontinuation of acyclovir was significantly reduced in the adult population.

    Michelle Chicoineau, PharmD1, Elizabeth Cady, PharmD1,2 and Natalie Tucker, PharmD1, (1)Pharmacy, HSHS St. John's Hospital, Springfield, IL, (2)Pharmacy Practice, Southern Illinois University at Edwardsville School of Pharmacy, Edwardsville, IL


    M. Chicoineau, None

    E. Cady, None

    N. Tucker, None

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