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Experience With Rapid Microarray-Based Diagnostic Technology and Antimicrobial Stewardship for Patients With Gram-Positive Bacteremia

Published online by Cambridge University Press:  08 August 2016

Elizabeth A. Neuner ,
Andrea M. Pallotta ,
Simon W. Lam ,
David Stowe ,
Steven M. Gordon ,
Gary W. Procop  and
Sandra S. Richter
Elizabeth A. Neuner*
Affiliation:
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
Andrea M. Pallotta
Affiliation:
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
Simon W. Lam
Affiliation:
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
David Stowe
Affiliation:
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
Steven M. Gordon
Affiliation:
Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
Gary W. Procop
Affiliation:
Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
Sandra S. Richter
Affiliation:
Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
*
Address correspondence to Elizabeth A. Neuner, PharmD, Department of Pharmacy, Cleveland Clinic, Cleveland, OH 44195 (neunere@ccf.org).
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Abstract

OBJECTIVE

To describe the impact of rapid diagnostic microarray technology and antimicrobial stewardship for patients with Gram-positive blood cultures.

DESIGN

Retrospective pre-intervention/post-intervention study.

SETTING

A 1,200-bed academic medical center.

PATIENTS

Inpatients with blood cultures positive for Staphylococcus aureus, Enterococcus faecalis, E. faecium, Streptococcus pneumoniae, S. pyogenes, S. agalactiae, S. anginosus, Streptococcus spp., and Listeria monocytogenes during the 6 months before and after implementation of Verigene Gram-positive blood culture microarray (BC-GP) with an antimicrobial stewardship intervention.

METHODS

Before the intervention, no rapid diagnostic technology was used or antimicrobial stewardship intervention was undertaken, except for the use of peptide nucleic acid fluorescent in situ hybridization and MRSA agar to identify staphylococcal isolates. After the intervention, all Gram-positive blood cultures underwent BC-GP microarray and the antimicrobial stewardship intervention consisting of real-time notification and pharmacist review.

RESULTS

In total, 513 patients with bacteremia were included in this study: 280 patients with S. aureus, 150 patients with enterococci, 82 patients with stretococci, and 1 patient with L. monocytogenes. The number of antimicrobial switches was similar in the pre–BC-GP (52%; 155 of 300) and post–BC-GP (50%; 107 of 213) periods. The time to antimicrobial switch was significantly shorter in the post–BC-GP group than in the pre–BC-GP group: 48±41 hours versus 75±46 hours, respectively (P<.001). The most common antimicrobial switch was de-escalation and time to de-escalation, was significantly shorter in the post-BC-GP group than in the pre–BC-GP group: 53±41 hours versus 82±48 hours, respectively (P<.001). There was no difference in mortality or hospital length of stay as a result of the intervention.

CONCLUSIONS

The combination of a rapid microarray diagnostic test with an antimicrobial stewardship intervention improved time to antimicrobial switch, especially time to de-escalation to optimal therapy, in patients with Gram-positive blood cultures.

Infect Control Hosp Epidemiol 2016;1–6

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 11 , November 2016 , pp. 1361 - 1366
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. Presented in part as poster 1492 at IDWeek, San Diego, California, October 10, 2015.

References

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