Impact of Antimicrobial Stewardship Intervention on Coagulase-Negative Staphylococcus Blood Cultures in Conjunction with Rapid Diagnostic Testing.

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Impact of Antimicrobial Stewardship Intervention on Coagulase-Negative Staphylococcus Blood Cultures in Conjunction with Rapid Diagnostic Testing.

J Clin Microbiol. 2014 May 28;

Authors: Nagel JL, Huang AM, Kunapuli A, Gandhi TN, Washer LL, Lassiter J, Patel T, Newton DW

Abstract
BACKGROUND: Rapid diagnostic testing with Matrix-Assisted Laser Desorption Ionization Time-of-Flight (MALDI-TOF) decreases time to organism identification by 24-36 hours compared to conventional methods. However, there is limited data evaluating the impact of MALDI-TOF with real-time antimicrobial stewardship team (AST) review and intervention on antimicrobial prescribing and outcomes for patients with bacteremia and blood cultures contaminated with coagulase-negative Staphylococcus (CoNS).
METHODS: A quasi-experimental study was conducted to analyze the impact of rapid diagnostic testing with MALDI-TOF plus AST review and intervention for adult hospitalized patients with blood cultures positive for CoNS. Antibiotic prescribing patterns and clinical outcomes were compared before and after implementation of MALDI-TOF with AST intervention for patients with CoNS bacteremia and CoNS contamination.
RESULTS: 324 patients with a positive CoNS blood culture were included; 246 were deemed to have contaminated cultures (117 in the pre-intervention group and 129 in AST intervention group), and 78 patients had bacteremia (46 pre-intervention and 32 AST intervention group). No differences in demographics were seen between groups, and similar rates of contamination occurred between the pre-intervention and AST intervention groups (64.3% vs. 72.6%, p=0.173). Patients with bacteremia were initiated on optimal therapy sooner in the AST intervention group (58.7 vs. 34.4 hours, p=0.030), which was associated with similar decreased morality (21.7% vs. 3.1%, p=0.023). Patients with CoNS contaminated cultures had similar rates of mortality, length of hospitalization, recurrent blood stream infection and 30-day hospital readmission, but the AST intervention group decreased the duration of unnecessary antibiotic therapy (1.31 vs 3.89 days, p=0.032), and decreased the number of vancomycin trough assays performed (0.88 vs 1.95, p<0.001).
CONCLUSIONS: In patients with CoNS bacteremia, rapid pathogen identification integrated with real-time stewardship interventions improved timely organism identification and initiation of antibiotic therapy. The AST group decreased inappropriate antimicrobial prescribing, and decreased unnecessary serum vancomycin trough assays for patients with blood cultures contaminated with CoNS.

PMID: 24871213 [PubMed - as supplied by publisher]