A Gram-negative (GN) blood culture microarray assay with an antimicrobial stewardship program (ASP) intervention was evaluated in 126 patients with GN bacteremia. The median time to optimal therapy was shorter in the postintervention group than in the preintervention group (49.3 h versus 38.5 h, respectively; P ؍ 0.0199). ASP can utilize microarray technology to decrease the time to optimal antimicrobial therapy.
The treatment of Gram-negative bloodstream infections (GN-BSI) is particularly complicated due to high rates of resistance from multiple resistance mechanisms, including the production of extended-spectrum -lactamase (ESBL) and carbapenemase enzymes, leaving limited treatment options (1, 2). Molecular diagnostic assays can produce results faster than traditional identification and susceptibility testing methods and may help decrease the time to appropriate antimicrobial therapy (3-18). The Verigene Gram-negative blood culture (BC-GN) assay (Nanosphere, Inc., Northbrook, IL) is a qualitative in vitro diagnostic test for the rapid detection and identification of select Gram-negative bacteria and resistance markers (17). The purpose of this study was to evaluate the impact of an antimicrobial stewardship program (ASP) on the time to optimal antimicrobial therapy, utilizing rapid organism and resistance identification via the BC-GN test, on patients with GN-BSI.This was a retrospective, quasiexperimental, and preintervention/postintervention study conducted at University of Florida Health and was approved by the University of Florida Health Science Center Jacksonville institutional review board. All inpatient adults with documented GN-BSI between 15 September 2013 and 15 February 2014 (pre-BC-GN period) and between 15 September 2014 and 15 February 2015 (post-BC-GN period) were evaluated for inclusion. Exclusion criteria included polymicrobial BSI, documented infections caused by organisms not identified by the BC-GN test, incarcerated patients, involvement with other investigational protocols, or death prior to culture results. During the pre-BC-GN period, the ASP reviewed the prescribed antimicrobial agents and provided pharmacotherapeutic recommendations to prescribers as microbiology information became available during normal business hours. In the postintervention period, the BC-GN test was performed according to the manufacturer's specifications (17), and the results were reported in a similar fashion as done previously (10). Microbiology paged the ASP 24 h per day, 7 days per week with BC-GN test results. The ASP contacted physicians during normal business hours with pharmacotherapeutic recommendations based on BC-GN test results. All BC-GN test results were confirmed by conventional microbiological methods, including rapid spot tests (oxidase and indole) and the Vitek 2 GN identification and GN-73 susceptibility cards (bioMérieux, Durham, NC).After retrospective identification of patients with GN-BSI, the electronic health record (EHR) was used to identify patients for inclusion and exclusion cri...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.