1063. Impact of Rapid Organism Identification and a Standardized Algorithm on Antimicrobial Therapy in Patients with Bacteremia.
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • IDWeek 2018 Poster_Koutsari.pdf (240.2 kB)
  • Background: Bloodstream infection is associated with 12% to 32% mortality. The FilmArray® BCID panel is a multiplex polymerase chain reaction assay (PCR) that can rapidly identify the most common bacterial pathogens in the blood and 3 antimicrobial resistance genes. In April 2015, Abbott Northwestern Hospital (ANW) implemented the multiplex PCR panel and a pharmacist-driven process to assist with antibiotic tailoring. In August 2017, a standardized algorithm was approved providing first-line and second-line antimicrobial options for each microbial pathogen included in the multiplex PCR panel. The objective of this study was to compare the time from the multiplex PCR panel result to final appropriate antibiotic therapy (as defined by the standardized algorithm or when clinical decision was indicated) between pre- and post-algorithm implementation in hospitalized patients with bacteremia.

    Methods: Retrospective chart review was performed in 93 randomly selected adult patients with ≥ 1 positive blood culture in November 2016-February 2017 (pre-algorithm) vs. 93 patients in November 2017-February 2018 (post-algorithm) at ANW.

    Results: The two groups did not differ significantly in terms of age (average ~60 years), sex (45% female), intensive care unit admission on day 1 of bacteremia (~41%), infectious diseases (ID) consult within 72 hours of bacteremia (average 72%), bacteremia source, or etiologic bacteria. The median time to final appropriate antibiotic therapy in response to the multiplex PCR result was 19 hours (interquartile range, IQR 4-38 hours) pre-algorithm and 18 hours (IQR 4-31 hours) post-algorithm (P=0.34).

    Conclusion: The median time from the multiplex PCR result to final appropriate antibiotic therapy was ~19 hours pre- and post-algorithm. Previous studies showed a median of 21 hours to first appropriate de-escalation. Therefore, ANW performs very well in de-escalating antimicrobial therapy promptly. However, most of the rapidity in antibiotic change was driven by ID providers, who treated >70% of patients. Opportunities for improvement exist for non-ID providers in tailoring antimicrobial therapy and for pharmacists in engaging and providing recommendations in a timely manner.

    Christina Koutsari, PharmD, PhD, BCPS, Krista Gens, PharmD, BCPS-AQ ID and Jessica Holt, PharmD, BCPS-AQ ID, Pharmacy, Abbott Northwestern Hospital, Minneapolis, MN

    Disclosures:

    C. Koutsari, None

    K. Gens, None

    J. Holt, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.