Impact of Rapid Organism Identification via Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Combined With Antimicrobial Stewardship Team Intervention in Adult Patients With Bacteremia and Candidemia
Angela M. Huang,Duane W. Newton,Anjly Kunapuli,Tejal N Gandhi,Laraine Washer,Jacqueline Isip,Curtis D. Collins,Jerod Nagel +7 more
TLDR
MALDI-TOF with AST intervention decreased time to organism identification and time to effective and optimal antibiotic therapy and acceptance of an AST intervention was associated with a trend toward reduced mortality on multivariable analysis.Abstract:
BACKGROUND Integration of rapid diagnostic testing via matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) with antimicrobial stewardship team (AST) intervention has the potential for early organism identification, customization of antibiotic therapy, and improvement in patient outcomes. The objective of this study was to assess the impact of this combined approach on clinical and antimicrobial therapy-related outcomes in patients with bloodstream infections. METHODS A pre-post quasi-experimental study was conducted to analyze the impact of MALDI-TOF with AST intervention in patients with bloodstream infections. The AST provided evidence-based antibiotic recommendations after receiving real-time notification following blood culture Gram stain, organism identification, and antimicrobial susceptibilities. Outcomes were compared to a historic control group. RESULTS A total of 501 patients with bacteremia or candidemia were included in the final analysis: 245 patients in the intervention group and 256 patients in the preintervention group. MALDI-TOF with AST intervention decreased time to organism identification (84.0 vs 55.9 hours, P < .001), and improved time to effective antibiotic therapy (30.1 vs 20.4 hours, P = .021) and optimal antibiotic therapy (90.3 vs 47.3 hours, P < .001). Mortality (20.3% vs 14.5%), length of intensive care unit stay (14.9 vs 8.3 days) and recurrent bacteremia (5.9% vs 2.0%) were lower in the intervention group on univariate analysis, and acceptance of an AST intervention was associated with a trend toward reduced mortality on multivariable analysis (odds ratio, 0.55, P = .075). CONCLUSION MALDI-TOF with AST intervention decreased time to organism identification and time to effective and optimal antibiotic therapy.read more
Citations
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Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America
Tamar F. Barlam,Tamar F. Barlam,Sara E. Cosgrove,Lilian M. Abbo,Conan MacDougall,Audrey N. Schuetz,Edward Septimus,Arjun Srinivasan,Timothy H. Dellit,Yngve Falck-Ytter,Neil O. Fishman,Cindy W. Hamilton,Timothy C. Jenkins,Pamela A. Lipsett,Preeti N. Malani,Larissa S May,Gregory J. Moran,Melinda M. Neuhauser,Jason G. Newland,Christopher A. Ohl,Matthew H. Samore,Susan K. Seo,Kavita K. Trivedi +22 more
TL;DR: These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics.
Journal ArticleDOI
Sepsis: a roadmap for future research
Jonathan Cohen,Jean Louis Vincent,Neill K. J. Adhikari,Flávia Ribeiro Machado,Derek C. Angus,Thierry Calandra,Katia Jaton,Stefano Giulieri,Julie Delaloye,Steven M. Opal,Kevin J. Tracey,Tom van der Poll,Eric Pelfrene +12 more
TL;DR: The understanding of the clinical epidemiology and management of sepsis is set out and how the present approaches might be challenged to develop a new roadmap for future research is asked.
Journal ArticleDOI
Randomized Trial of Rapid Multiplex Polymerase Chain Reaction–Based Blood Culture Identification and Susceptibility Testing
Ritu Banerjee,Christine B Teng,Scott A. Cunningham,Sherry M. Ihde,James M. Steckelberg,James P. Moriarty,Nilay Shah,Jayawant N. Mandrekar,Robin Patel +8 more
TL;DR: A prospective randomized controlled trial evaluating outcomes associated with rapid multiplex PCR detection of bacteria, fungi, and resistance genes directly from positive BCBs found that rmPCR reported with templated comments reduced treatment of contaminants and use of broad-spectrum antimicrobials.
Journal ArticleDOI
The Effect of Molecular Rapid Diagnostic Testing on Clinical Outcomes in Bloodstream Infections: A Systematic Review and Meta-analysis
Tristan T Timbrook,Tristan T Timbrook,Jacob B. Morton,Jacob B. Morton,Kevin W. McConeghy,Aisling R. Caffrey,Aisling R. Caffrey,Eleftherios Mylonakis,Kerry L. LaPlante,Kerry L. LaPlante +9 more
TL;DR: For BSIs, mR DT was associated with significant decreases in mortality risk in the presence of a ASP, but not in its absence, and mRDT decreased the time to effective therapy and the length of stay.
Journal ArticleDOI
Executive Summary: Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America.
Tamar F. Barlam,Sara E. Cosgrove,Lilian M. Abbo,Conan MacDougall,Audrey N. Schuetz,Edward Septimus,Arjun Srinivasan,Timothy H. Dellit,Yngve Falck-Ytter,Neil O. Fishman,Cindy W. Hamilton,Timothy C. Jenkins,Pamela A. Lipsett,Preeti N. Malani,Larissa S May,Gregory J. Moran,Melinda M. Neuhauser,Jason G. Newland,Christopher A. Ohl,Matthew H. Samore,Susan K. Seo,Kavita K. Trivedi +21 more
TL;DR: These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics.
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