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.
J. Holt, None