Studies have shown molecular rapid diagnostic testing (RDT) have been associated with improved clinical outcomes in bloodstream infections when combined with antimicrobial stewardship (AMS) intervention. Mercy Medical Center implemented the RDT Verigene® Blood-Culture Gram-Negative and Gram-Positive panels. After implementation, our prior study that evaluated time to optimal therapy after implementation of Verigene along with AMS intervention showed an improved time to optimal therapy (65 vs 33 hours, p<0.001). However, the process implemented was labor intensive for the AMS team to provide coverage 7 days per week. Therefore, we incorporated clinical pharmacists (CP) to provide coverage during evenings and weekends.
We performed a single-center, retrospective analysis of adult patients who were identified as having a positive blood culture from January 2016 to October 2017. The primary outcome was appropriateness of the CP recommendation based on RDT results compared to AMS recommendations. Secondary outcomes were time to RDT follow-up, and time to optimal antibiotic therapy. A survey of CP assessed workflow and confidence in performing this task. We evaluated each pharmacist’s recommendation based on RDT results, patient specific criteria, and antimicrobial reference tool. Suboptimal recommendations included: no de-escalation, no escalation to effective coverage, or lack of discontinuation.
A total of 160 adult patients, 80 in each group were included. The AMS group provided optimal antibiotic therapy recommendations more often than CP (94% vs 70%, p<0.001). Time to follow-up by CP was significantly shorter compared to AMS (3.8 vs 11; p <0.001). The majority of the suboptimal recommendations were due to no de-escalation of antibiotic therapy. Time to optimal therapy was similar between groups (24.5 vs 28; p=0.920). A third of CP stated they are unlikely to recommend de-escalation to optimal therapy if patients were on effective therapy.
CP can be utilized to expand coverage of RDT follow-up. The AMS team did provide significantly more optimal antimicrobial recommendations compared to CP. This study shows there is a need for continued education of CP on the importance of de-escalating patients to optimal antimicrobial therapy.
J. Brock, None
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