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182. Impact of Rapid Identification and Phenotypic Results on Clinical, Economic, Antimicrobial Stewardship Outcomes in Patients with Gram-Negative Bacteremia

BACKGROUND: Timely and effective antibiotic therapy is a critical determinant of clinical outcome in Gram-negative bacilli (GNB) bloodstream infections (BSI). Conventional antimicrobial susceptibility testing (AST) remains a rate-limiting step in determining targeted therapy. Accelerate Pheno(™) (AP...

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Autores principales: Shoop, Harold, Fabian, Amy, Doyen, Shaina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9751767/
http://dx.doi.org/10.1093/ofid/ofac492.260
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author Shoop, Harold
Fabian, Amy
Doyen, Shaina
author_facet Shoop, Harold
Fabian, Amy
Doyen, Shaina
author_sort Shoop, Harold
collection PubMed
description BACKGROUND: Timely and effective antibiotic therapy is a critical determinant of clinical outcome in Gram-negative bacilli (GNB) bloodstream infections (BSI). Conventional antimicrobial susceptibility testing (AST) remains a rate-limiting step in determining targeted therapy. Accelerate Pheno(™) (AP) is a novel system providing both identification (ID) and AST results within 8 hours. The primary objective of this study was to determine the impact of rapid ID and AST with AP on time to achieving targeted therapy (TTT). METHODS: This single center, quasi-experimental study compared outcomes with AP (POST; November 2020 to July 2021) versus a historical standard (PRE; November 2019 to July 2020) of rapid diagnostic testing (BioFire® FilmArray®BCID) and conventional AST (VITEK®2) with pharmacist-driven antimicrobial stewardship (AMS) intervention. PRE and POST BSI were retrospectively identified by positive blood culture (BCx) with an on-panel GNB. Inpatients were excluded if less than 18 years of age, pregnant, polymicrobial BCx, BCx with the same organism and source within 7 days, or if died or transitioned to palliative or hospice care before final AST results. Secondary outcomes included inpatient all-cause mortality, hospital and ICU length of stay, hospital-acquired Clostridioides difficile infection, antibiotic and microbiologic costs, days of anti-pseudomonal therapy, antibiotic intensity score, and time to first intervention following Gram stain, ID, and AST results. RESULTS: Overall, 373 BSI were screened and 294 were included [161 PRE vs 133 POST]. Baseline demographics and characteristics were similar between groups. Median TTT was shorter POST [50 hours (IQR 44–92) vs 28 hours (IQR 14–55), p < 0.05]. Median microbiology testing costs per episode were higher POST [Δ$40.33 (32%), p < 0.05]. Other secondary outcomes did not differ significantly between groups. Pharmacists intervened more POST [69 (43%) vs 77 (58%), p < 0.05]. AP completed ID and AST in 155 of 205 (76%) BSI. Off-panel GNB occurred in 26 (13%) BSI POST. CONCLUSION: Implementing the AP system together with an established AMS program resulted in a shorter TTT and a higher cost to test. Clinical, AMS, and other economic outcomes were not impacted by the addition of AP. DISCLOSURES: All Authors: No reported disclosures.
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spelling pubmed-97517672022-12-16 182. Impact of Rapid Identification and Phenotypic Results on Clinical, Economic, Antimicrobial Stewardship Outcomes in Patients with Gram-Negative Bacteremia Shoop, Harold Fabian, Amy Doyen, Shaina Open Forum Infect Dis Abstracts BACKGROUND: Timely and effective antibiotic therapy is a critical determinant of clinical outcome in Gram-negative bacilli (GNB) bloodstream infections (BSI). Conventional antimicrobial susceptibility testing (AST) remains a rate-limiting step in determining targeted therapy. Accelerate Pheno(™) (AP) is a novel system providing both identification (ID) and AST results within 8 hours. The primary objective of this study was to determine the impact of rapid ID and AST with AP on time to achieving targeted therapy (TTT). METHODS: This single center, quasi-experimental study compared outcomes with AP (POST; November 2020 to July 2021) versus a historical standard (PRE; November 2019 to July 2020) of rapid diagnostic testing (BioFire® FilmArray®BCID) and conventional AST (VITEK®2) with pharmacist-driven antimicrobial stewardship (AMS) intervention. PRE and POST BSI were retrospectively identified by positive blood culture (BCx) with an on-panel GNB. Inpatients were excluded if less than 18 years of age, pregnant, polymicrobial BCx, BCx with the same organism and source within 7 days, or if died or transitioned to palliative or hospice care before final AST results. Secondary outcomes included inpatient all-cause mortality, hospital and ICU length of stay, hospital-acquired Clostridioides difficile infection, antibiotic and microbiologic costs, days of anti-pseudomonal therapy, antibiotic intensity score, and time to first intervention following Gram stain, ID, and AST results. RESULTS: Overall, 373 BSI were screened and 294 were included [161 PRE vs 133 POST]. Baseline demographics and characteristics were similar between groups. Median TTT was shorter POST [50 hours (IQR 44–92) vs 28 hours (IQR 14–55), p < 0.05]. Median microbiology testing costs per episode were higher POST [Δ$40.33 (32%), p < 0.05]. Other secondary outcomes did not differ significantly between groups. Pharmacists intervened more POST [69 (43%) vs 77 (58%), p < 0.05]. AP completed ID and AST in 155 of 205 (76%) BSI. Off-panel GNB occurred in 26 (13%) BSI POST. CONCLUSION: Implementing the AP system together with an established AMS program resulted in a shorter TTT and a higher cost to test. Clinical, AMS, and other economic outcomes were not impacted by the addition of AP. DISCLOSURES: All Authors: No reported disclosures. Oxford University Press 2022-12-15 /pmc/articles/PMC9751767/ http://dx.doi.org/10.1093/ofid/ofac492.260 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstracts
Shoop, Harold
Fabian, Amy
Doyen, Shaina
182. Impact of Rapid Identification and Phenotypic Results on Clinical, Economic, Antimicrobial Stewardship Outcomes in Patients with Gram-Negative Bacteremia
title 182. Impact of Rapid Identification and Phenotypic Results on Clinical, Economic, Antimicrobial Stewardship Outcomes in Patients with Gram-Negative Bacteremia
title_full 182. Impact of Rapid Identification and Phenotypic Results on Clinical, Economic, Antimicrobial Stewardship Outcomes in Patients with Gram-Negative Bacteremia
title_fullStr 182. Impact of Rapid Identification and Phenotypic Results on Clinical, Economic, Antimicrobial Stewardship Outcomes in Patients with Gram-Negative Bacteremia
title_full_unstemmed 182. Impact of Rapid Identification and Phenotypic Results on Clinical, Economic, Antimicrobial Stewardship Outcomes in Patients with Gram-Negative Bacteremia
title_short 182. Impact of Rapid Identification and Phenotypic Results on Clinical, Economic, Antimicrobial Stewardship Outcomes in Patients with Gram-Negative Bacteremia
title_sort 182. impact of rapid identification and phenotypic results on clinical, economic, antimicrobial stewardship outcomes in patients with gram-negative bacteremia
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9751767/
http://dx.doi.org/10.1093/ofid/ofac492.260
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