Rapid pathogen identification can alter antibiotic prescribing practices if interpreted correctly. Microbiology reporting can be difficult to understand, and new technology has made it more challenging. Nebraska Medicine recently implemented the BioFire FilmArray blood culture identification panel (BCID) coupled with stewardshipbased education on interpretation. Physician BCID result interpretation and prescribing were assessed via an electronic survey, with a response rate of 40.8% (156/382 surveys). Seven questions required respondents to interpret BCID results, identify the most likely pathogen, and then choose therapy based on the results. The tallied correct responses resulted in a knowledge score. General linear models evaluated the effect of role, specialty, and utilization of the BCID interpretation guide on the mean knowledge score. The specialties of the respondents included 55.7% internal medicine, 19.7% family medicine, and 24.6% other. Roles included 41.1% residents, 5.0% fellows, and 53.9% faculty. Most reported that they reviewed antimicrobial susceptibility results (89.4%) and adjusted therapy accordingly (81.6%), while only 60% stated that they adjusted therapy based on BCID results. The correct response rates ranged from 52 to 86% for the interpretation questions. The most common errors included misinterpretation of Enterobacteriaceae and Staphylococcus genus results. Neither role nor specialty was associated with total knowledge score in multivariate analysis (P ϭ 0.13 and 0.47, respectively). In conclusion, physician interpretation of BCID results is suboptimal and can result in ineffective treatment or missed opportunity to narrow therapy. With the implementation of new technology, improved reporting practices of BCID results with clinical decision support tools providing interpretation guidance available at the point of care is recommended.KEYWORDS antibiotic prescribing, antibiotic treatment, antimicrobial stewardship, bacteremia, blood culture, bloodstream infections, clinical decision support, microbiology laboratory results, rapid diagnostic testing, sepsis T est results produced by the clinical microbiology laboratory provide fundamental data for the initiation and modification of effective antimicrobial therapy. Substandard patient care can result if laboratory-generated data are not clearly reported in a format easily understood by the physician. While the laboratory may report accurate and sufficient data, the physician may not understand or interpret the data correctly based on the report's format or terminology. The potential disparity between report content and report cognition increases the potential for patient care issues. Communication with the physician through microbiology reports needs to be effective, with unambiguous interpretations that lead to optimal therapeutic choices.
One health is a transdisciplinary approach to achieve optimal health for humans, animals, plants and their shared environment, recognizing the interconnected nature of health in these domains. Field based research is needed to connect the occurrence of antibiotics used in veterinary medicine and human health with the presence of antibiotic resistance genes (ARGs).
Background Antibiotic resistance is a significant public health threat and widespread use of antibiotics in agriculture is increasing the concern about agricultural contributions to the dissemination of antibiotic resistant bacteria. Of concern is the level of exposure to antibiotics and antibiotic-resistant bacteria in the watershed. Consequently, adopting a One Health approach to measure antibiotic levels and identify antibiotic resistance gene (ARG) transfer at the human, animal and environmental interfaces is essential to better understand how antibiotic resistance is spread. Methods In this project, antibiotic levels were measured using passive organic chemical integrative samplers (POCIS) for 30-day periods from August – November 2018 from Elkhorn River and Shell Creek watersheds in Nebraska (Figure 1). In addition, whole genome sequences of bacterial isolates cultured from the watersheds were assessed to identify ARGs present on mobile genetic elements (MGE) that had >95% similarity to mobile ARG present in isolates recorded in the NCBI GenBank database was identified using ResFinder. Figure 1. Sampling locations within the two watersheds. Results The study demonstrated significant antibiotic levels present throughout the watershed, with five of them associated with human usage (Table 1). In addition, seasonally based drug-resistant bacterial species was associated with specific antibiotic levels in the watershed (Figure 2). Mobile ARGs were detected in 87.5% of isolates collected from the Elkhorn River and 80.0% within Shell Creek (Figure 3). Table 1. Pharmaceutical levels in the watershed Figure 2. Antibiotic levels and drug-resistant bacteria in the watershed Figure 3. Antibiotic resistance observed from each isolate at every sampling date and site. A colored bar denotes that resistance to that antibiotic was observed. Conclusion These results present evidence of transfer of highly mobile ARGs between environment, clinical, and animal-associated bacteria and highlight the need for a One Health perspective in assessing the spread of antibiotic resistance. The presence of significant levels of antibiotics persisting in this agricultural watershed points out the need for ongoing monitoring of compliance with the Food and Drug Administration (FDA) recommendation of veterinarian oversight of the use of antibiotics in the use of veterinary feed directive applications. Disclosures All Authors: No reported disclosures
Microbiology laboratory classes allow students to make connections between theoretical concepts and clinical practice through experiential learning. In the past, most laboratory sessions were taught in-person, on-site.
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