Delays in time to appropriate management and antimicrobial therapy in patients with Staphylococcus aureus bacteremia (SAB) lead to dramatic increases in mortality, cost, and length of hospital stay. This study assesses the impact of antimicrobial stewardship pharmacist (ASP)-led Verigene education sessions paired with a physician targeted EPIC best practice alert (BPA) on time to appropriate therapy and rate of Infectious Diseases (ID) consult for patients SAB.
This single-center pre-post study included adult patients with SAB from 10/2016 through 1/2018. A BPA was implemented in August 2017, and fired for any patient with SAB and no ID consult. The BPA provided 4 recommendations: 1) repeat blood cultures till clearance, 2) obtain ID consult, 3) start vancomycin for SAB with mecA gene (i.e. MRSA) and nafcillin or cefazolin for SAB without mecA gene (i.e. MSSA), and 4) obtain echocardiogram. The ASP also provided education on antimicrobial therapy choices and optimization to clinical pharmacists and ID physicians. The hospital utilized Verigene Gram-positive blood culture nucleic acid test during both study periods and ASP review of SAB cases without an ID consult in the pre-intervention phase. The primary outcome was time to appropriate therapy defined as the time a positive blood culture was drawn to the time of first appropriate antibiotic administration.
Results: A total of 223 patients with SAB were included; 134 were in the 10-month historic group (10/16-7/17) and 89 were in the 5-month post-intervention (PI) group (8/17-1/18). The BPA fired for 86% (n=77) of patients in the PI group. Average time to appropriate therapy for all SAB patients and patients with MSSA significantly improved following the intervention (35.1 vs. 20.4 hours, p=0.004; 53.2 vs 30.3 hours, p=0.001). During the intervention phase, therapy was more frequently changed between the time of Verigene results and antibiotic susceptibilities (77.6% vs. 86.5%, p=0.254). The rate of ID consult also significantly improved following the intervention (89.6% vs. 97.8%, p<0.02).
Implementing a SAB BPA and education on interpretation of Verigene results for SAB, significantly improved time to appropriate therapy for all patients with SAB, patients with MSSA bacteremia, and rate of ID consult.
C. Zimmerman, None
R. Chang, None
J. Nagel, None
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