» Articles » PMID: 32601164

Pharmacist-Driven Implementation of Fast Identification and Antimicrobial Susceptibility Testing Improves Outcomes for Patients with Gram-Negative Bacteremia and Candidemia

Overview
Specialty Pharmacology
Date 2020 Jul 1
PMID 32601164
Citations 10
Authors
Affiliations
Soon will be listed here.
Abstract

Bloodstream infections (BSI) are associated with increased morbidity and mortality, especially when caused by Gram-negative or fungal pathogens. The objective of this study was to assess the impact of fast identification-antimicrobial susceptibility testing (ID/AST) with the Accelerate Pheno system (AXDX) from May 2018 to December 2018 on antibiotic therapy and patient outcomes. A pre-post quasiexperimental study of 200 patients (100 pre-AXDX implementation and 100 post-AXDX implementation) was conducted. The primary endpoints measured were time to first antibiotic intervention, time to most targeted antibiotic therapy, and 14-day hospital mortality. Secondary endpoints included hospital and intensive care unit (ICU) length of stay (LOS), antibiotic intensity score at 96 h, and 30-day readmission rates. Of 100 patients with Gram-negative bacteremia or candidemia in each cohort, 84 in the preimplementation group and 89 in the AXDX group met all inclusion criteria. The AXDX group had a decreased time to first antibiotic intervention (26.3 versus 8.0, = 0.003), hours to most targeted therapy (14.4 versus 9, = 0.03), hospital LOS (6 versus 8, = 0.002), and average antibiotic intensity score at 96 h (16 versus 12, = 0.002). Both groups had a comparable 14-day mortality (0% versus 3.6%, = 0.11). In this analysis of patients with Gram-negative bacteremia or candidemia, fast ID/AST implementation was associated with decreased hospital LOS, decreased use of broad-spectrum antibiotics, shortened time to targeted therapy, and an improved utilization of antibiotics within the first 96 h of therapy.

Citing Articles

Evaluating the impact of rapid antimicrobial susceptibility testing for bloodstream infections: a review of actionability, antibiotic use and patient outcome metrics.

MacVane S, Dwivedi H J Antimicrob Chemother. 2024; 79(Supplement_1):i13-i25.

PMID: 39298359 PMC: 11412245. DOI: 10.1093/jac/dkae282.


Combination of a Rapid Diagnostic Assay and Antimicrobial Stewardship Intervention for Gram-Negative Bacteremia.

Ventres J, Ting M, Parente D, Rogers R, Norris A, Benitez G Open Forum Infect Dis. 2024; 11(9):ofae477.

PMID: 39263216 PMC: 11389609. DOI: 10.1093/ofid/ofae477.


Simplified Spectrum Score (S) app for pathogen-agnostic antimicrobial drug spectrum ranking to assess for antimicrobial de-escalation events.

de Lorenzi-Tognon M, Schrenzel J Sci Rep. 2024; 14(1):9776.

PMID: 38684841 PMC: 11059348. DOI: 10.1038/s41598-024-60041-6.


Clinical impact of the accelerate PhenoTest® BC system on patients with gram-negative bacteremia and high risk of antimicrobial resistance: a prospective before-after implementation study.

Brosh-Nissimov T, Tzur A, Grupel D, Cahan A, Maaravi N, Heled-Akiva M Ann Clin Microbiol Antimicrob. 2023; 22(1):62.

PMID: 37516885 PMC: 10387206. DOI: 10.1186/s12941-023-00619-6.


Impact of a Pharmacist-Managed Procalcitonin Program on COVID-19 Respiratory Tract Infection Outcomes and Health Care Resource Utilization.

Fratoni A, Kois A, Colmerauer J, Linder K, Nicolau D, Kuti J Open Forum Infect Dis. 2022; 9(9):ofac468.

PMID: 36176570 PMC: 9494375. DOI: 10.1093/ofid/ofac468.


References
1.
Maurer F, Christner M, Hentschke M, Rohde H . Advances in Rapid Identification and Susceptibility Testing of Bacteria in the Clinical Microbiology Laboratory: Implications for Patient Care and Antimicrobial Stewardship Programs. Infect Dis Rep. 2017; 9(1):6839. PMC: 5391540. DOI: 10.4081/idr.2017.6839. View

2.
Lockwood A, Perez K, Musick W, Ikwuagwu J, Attia E, Fasoranti O . Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time. Infect Control Hosp Epidemiol. 2016; 37(4):425-32. DOI: 10.1017/ice.2015.313. View

3.
Madaras-Kelly K, Jones M, Remington R, Caplinger C, Huttner B, Samore M . Description and validation of a spectrum score method to measure antimicrobial de-escalation in healthcare associated pneumonia from electronic medical records data. BMC Infect Dis. 2015; 15:197. PMC: 4418054. DOI: 10.1186/s12879-015-0933-9. View

4.
Kang C, Kim S, Beom Park W, Lee K, Kim H, Kim E . Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother. 2005; 49(2):760-6. PMC: 547233. DOI: 10.1128/AAC.49.2.760-766.2005. View

5.
Ibrahim E, Sherman G, Ward S, Fraser V, Kollef M . The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000; 118(1):146-55. DOI: 10.1378/chest.118.1.146. View