Methods: A retrospective cohort study was conducted in adult inpatients with blood cultures positive for Gram positive cocci in clusters. The pre-implementation, control group (CG) included patients from 4/2017-10/2017 and the post-implementation, intervention group (IG) was from 10/2017-4/2018. Patients < 18 years and polymicrobial bacteremia were excluded. Data collected in addition to primary and secondary outcomes included baseline demographics, allergies and empiric antibiotics. OAT included vancomycin for MRSA-B or MSSA-B with severe β-lactam allergy; nafcillin or cefazolin for MSSA-B; and discontinuation of vancomycin for CoNS deemed a contaminant.
Results: Of the 544 patients reviewed, 434 met inclusion criteria: 182 in the CG and 252 in the IG with similar baseline characteristics. Mean time to OAT decreased from 10 hours in the CG to 5 hours in the IG (P = 0.006). Time to BCC in the CG and IG cohorts decreased from 100 to 43 hours (P = 0.0001). One day of vancomycin was avoided in patients with MSSA-B and 2 days with CoNS. 30-day mortality decreased from 18% (n = 32) in the CG versus 6% (n = 15) in the IG (P = 0.0001). Finally, 95% (n = 153/161) of pharmacist interventions were accepted.
Conclusion: Utilizing the on-call pharmacy resident for notification of rapid diagnostic results for S. aureus bacteremia, we saw a significant decrease in time to OAT, BCC, and 30-day mortality. Our study demonstrates that in the setting of limited stewardship resources, additional members of the health care team can be used to optimize antibiotics in conjunction with rapid diagnostics.
D. Peaper, None
J. Topal, None
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