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Rapid identification of gram‐negative bacteremia and impact on antipseudomonal antibiotic consumption with antimicrobial stewardship at a community hospital system
Author(s) -
Box Maggie J.,
Lee Jennifer M.,
Ortiz Courtney D.,
Ortwine Kristine N.,
Richardson Caitlin A.,
Sullivan Eva L.,
Wong Samantha S.
Publication year - 2019
Publication title -
journal of the american college of clinical pharmacy
Language(s) - English
Resource type - Journals
ISSN - 2574-9870
DOI - 10.1002/jac5.1013
Subject(s) - medicine , antimicrobial stewardship , antibiotics , bacteremia , antibiotic resistance , antimicrobial , defined daily dose , klebsiella pneumoniae , intensive care unit , intensive care medicine , microbiology and biotechnology , nursing , medical prescription , escherichia coli , chemistry , biochemistry , gene , biology
Background Rapid identification of gram‐negative bacteremia can improve time to effective antibiotic therapy and antibiotic de‐escalation; however, there are little data that quantify the change in antibiotic utilization. This study evaluates the impact of the Verigene gram‐negative blood culture test (BC‐GN) in combination with an antimicrobial stewardship team (AST) intervention on antipseudomonal (AP) antibiotic utilization in a community hospital system among infections where AP antibiotics are not necessary. Methods This multicenter, pre‐post, quasi‐experimental pilot study was conducted at Scripps Health in San Diego, California. Internal antibiogram data was reviewed, and among the 4 targets of Escherichia coli , Klebsiella pneumoniae , Klebsiella oxytoca , and Proteus species (that lacked resistance genes) detected by the BC‐GN test, antimicrobial sensitivities did not warrant therapy with AP antibiotics. The BC‐GN test was performed at each site where clinical pharmacists notified physicians of results and assisted with antibiotic modifications. The primary end point was AP vs non‐AP antibiotic consumption within the first 5 days of admission. This was measured by days of therapy per patient day (DOT/PD). Secondary end points included hospital and intensive care unit (ICU) length of stay (LOS) and mortality. Results A total of 1051 patients were included; 512 in the pre‐intervention group, and 539 in the intervention group. Compared with the pre‐intervention group, AP antibiotic consumption significantly decreased (0.4 vs 0.2 DOT/PD, P < .0001) and non‐AP antibiotic consumption significantly increased (0.6 vs 0.8 DOT/PD, P < .0001) in the intervention group. Overall median LOS was 5 days vs 5 days ( P = .85) and median ICU LOS was 3 days vs 2 days ( P = .12), in the pre‐intervention and intervention groups, respectively. Mortality was similar between groups (7.0% vs 5.2% in the pre‐intervention and intervention groups, P = .21). Conclusion Rapid identification of gram‐negative bacteremia with AST intervention decreased AP antibiotic consumption among infections caused by pathogens where AP coverage is not needed.