Outcomes of Rapid Identification of Multi-Drug Resistant Gram-Negative Organisms Causing Bacteremia in Combination with Antimicrobial Stewardship in a Community Health System.

BACKGROUND: Rapid initiation of effective antibiotic therapy has been strongly associated with a decrease in mortality in gram-negative (GN) bacteremia. In an effort to improve time to effective antibiotic therapy in the treatment of multi-drug resistant (MDR) GN bacteremia, we implemented Verigene GN Blood Culture (BC-GN) assay, which can rapidly identify GN bacteria at the genus/species level and specific resistance markers from blood cultures within 2 hours of positivity. METHODS: The objective of this multi-center, pre-post quasi-experimental study was to assess outcomes of Verigene BC-GN in combination with antibiotic stewardship in treatment of MDR GN bacteremia. A retrospective chart review was performed one year prior and four months post-implementation of Verigene BC-GN. Patients > 18 years old with MDR GN bacteremia identified by Verigene BC-GN within 5 days of admission were included. The primary endpoint was time to effective antibiotic therapy for MDR GN bacteremia. Secondary outcomes included overall and ICU length of stay (LOS) and 30-day mortality. Education regarding interpretation of resistance markers and selection of optimal antibiotic therapy was provided to pharmacists and physicians prior to implementation. RESULTS: A total of 110 patients were included, 86 in the pre-intervention group and 24 in the post-intervention group. Mean time to effective antibiotic therapy decreased significantly from 47.6 ± 23.1 vs. 18.8 ± 9.1 hours, respectively (P < 0.0001). Median overall LOS was 6.0 vs 5.5 days (P = 0.88), ICU LOS was 3.0 vs 4.0 days (P = 0.57), and 30-day mortality was 4.7% vs 4.2% (P = 1) pre and post-implementation, respectively. CONCLUSION: Verigene BC-GN, in combination with antibiotic stewardship, successfully improved time to effective antibiotic therapy among MDR GN organisms causing bacteremia. DISCLOSURES: All authors: No reported disclosures.