1800. Clinical Impact of Real-Time Predictive Model to Facilitate Antibiotic Prescribing in Gram-Negative Bacteremia
Session: Poster Abstract Session: Antimicrobial Stewardship: Impact of New Diagnostics
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • PAT Poster 2018.pdf (391.0 kB)
  • Background: Delay in effective antibiotic administration in severe infections such as bacteremia is associated with worse clinical outcomes. We implemented previously validated software that uses real-time predictive modeling to determine patient-specific antibiograms (PS-ABG). The software allowed prescribers to run the model on their individual patients. It also automatically evaluated positive blood cultures, alerting the antibiotic stewardship team if there was <90% chance of the organism being susceptible to current antibiotic therapy.

    Methods: We performed a quasi-experimental study to evaluate clinical outcomes in patients with Gram-negative rod (GNR) bacteremia 18 months before (PRE) and 6 months after (POST) implementation of the software. Primary outcome was median time to effective antibiotic. Secondary outcomes included in-hospital mortality, utilization of antibiotics used for multidrug-resistant GNRs (MDR-GNR), median time to effective antibiotic in organisms resistant to at least one first-line antibiotic for sepsis, and length of stay.

    Results: The change per month in the primary outcome did not differ between the PRE and POST periods (p=0.48) (Figure). Time to effective antibiotics in GNR bloodstream infections that were resistant to at least one first-line antibiotic for sepsis (cefepime, piperacillin-tazobactam, or levofloxacin) was lower following the intervention (15.8 hours v. 13.7 hours, p=0.11), and mortality decreased following the intervention (14.6% v. 10.0%, p=0.11) although these differences were not statistically significant. There was no difference in other secondary outcomes between PRE and POST groups: length of stay (7.7 v. 7.5 days, p=0.74) and days of therapy of MDR-GNR agents per 30 days of hospitalization (3.5 v. 2.5, p=0.09).

    Conclusion: There was no difference in median time to effective antibiotic in all patients with GNR bacteremia. There was lower in-hospital mortality in the POST group and shorter time to effective antibiotic therapy in GNR bacteremia resistant to at least one first-line antibiotic for sepsis, although these differences were not statistically significant. Additional study in larger cohorts over longer periods is warranted to determine if PS-ABGs improve clinical outcomes in patients with more resistant GNR bacteremia.

    Description: Macintosh HD:Users:keithhamilton:Desktop:Figure 1.png

    Keith W. Hamilton, MD1, Valerie Cluzet, MD2, Leigh Cressman, MA3, Warren Bilker, PhD3, Ebbing Lautenbach, MD, MPH, MSCE, FIDSA, FSHEA4 and for the CDC Prevention Epicenters Program, (1)University of Pennsylvania, Philadelphia, PA, (2)Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, (3)Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, (4)Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

    Disclosures:

    K. W. Hamilton, None

    V. Cluzet, None

    L. Cressman, None

    W. Bilker, None

    E. Lautenbach, None

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