Automated Alerts Coupled with Antimicrobial Stewardship Intervention Lead to Decreases in Length of Stay in Patients with Gram-Negative Bacteremia

Pogue, Jason M.; Mynatt, Ryan P.; Marchaim, Dror; Zhao, Jing; Barr, Viktorija O.; Moshos, Judy; Sunkara, Bharath; Chopra, Teena; Chidurala, Sowmya; Kaye, Keith S.

doi:10.1086/674849

Cited by 53 publications

(30 citation statements)

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“…Compared to other studies that have used simulated samples, proposed theoretical benefits from antimicrobial interventions, and/or excluded polymicrobial cultures, this study aimed to provide a practical reference for the effects of this technology on laboratory turnaround times and patient care in a real-world hospital setting (16)(17)(18)(19)(20)(21)(22). While others have bundled rapid bloodstream infection diagnostics with improved stewardship practices for their analyses (9,17), it has been shown that antimicrobial stewardship interventions for Gram-negative bacteremia alone can improve outcomes (23). From a laboratory perspective, it was encouraging that our data demonstrated a positive clinical impact based on the BC-GN test with the antimicrobial stewardship practices that were already in place.…”

Section: Discussionmentioning

confidence: 99%

Clinical Impact of Laboratory Implementation of Verigene BC-GN Microarray-Based Assay for Detection of Gram-Negative Bacteria in Positive Blood Cultures

et al. 2016

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c Gram-negative bacteremia is highly fatal, and hospitalizations due to sepsis have been increasing worldwide. Molecular tests that supplement Gram stain results from positive blood cultures provide specific organism information to potentially guide therapy, but more clinical data on their real-world impact are still needed. We retrospectively reviewed cases of Gram-negative bacteremia in hospitalized patients over a 6-month period before (n ‫؍‬ 98) and over a 6-month period after (n ‫؍‬ 97) the implementation of a microarray-based early identification and resistance marker detection system (Verigene BC-GN; Nanosphere) while antimicrobial stewardship practices remained constant. Patient demographics, time to organism identification, time to effective antimicrobial therapy, and other key clinical parameters were compared. The two groups did not differ statistically with regard to comorbid conditions, sources of bacteremia, or numbers of intensive care unit (ICU) admissions, active use of immunosuppressive therapy, neutropenia, or bacteremia due to multidrug-resistant organisms. The BC-GN panel yielded an identification in 87% of Gram-negative cultures and was accurate in 95/97 (98%) of the cases compared to results using conventional culture. Organism identifications were achieved more quickly post-microarray implementation (mean, 10.9 h versus 37.9 h; P < 0.001). Length of ICU stay, 30-day mortality, and mortality associated with multidrug-resistant organisms were significantly lower in the postintervention group (P < 0.05). More rapid implementation of effective therapy was statistically significant for postintervention cases of extended-spectrum beta-lactamase-producing organisms (P ‫؍‬ 0.049) but not overall (P ‫؍‬ 0.12). The Verigene BC-GN assay is a valuable addition for the early identification of Gram-negative organisms that cause bloodstream infections and can significantly impact patient care, particularly when resistance markers are detected. Bloodstream infection remains one of the deadliest and costliest conditions in the United States, more than doubling between 2000 and 2008 and becoming the sixth most common reason for hospitalization (1). Gram-negative bacteremia has become an ever more pressing public health concern, as numbers across the globe continue to rise (2, 3). Although Gram-negative organisms are only responsible for ϳ30% of cases of hospitalacquired infections, they account for 70% of such cases in intensive care units (ICU) in the United States (4). These organisms, including multidrug-resistant (MDR) Pseudomonas aeruginosa and extended-spectrum beta-lactamase (ESBL) or carbapenemresistant Enterobacteriaceae (CRE), are associated with higher mortality rates (1, 3, 4).A timely and appropriate antimicrobial therapy selection is of particular importance. Delays in effective therapy and ineffective empirical therapy are associated with increased patient mortality (4-7). Growing evidence suggests that appropriate, early antibiotic therapy can improve patient outcomes (3,4,6,8). New rapid m...

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Section: Discussionmentioning

confidence: 99%

Clinical Impact of Laboratory Implementation of Verigene BC-GN Microarray-Based Assay for Detection of Gram-Negative Bacteria in Positive Blood Cultures

et al. 2016

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“…Further, the beneficial aspects of clinical decision support tools have been documented in the literature as well. [14][15][16] …”

Section: Discussionmentioning

confidence: 99%

Facilitators and barriers to implementing antimicrobial stewardship strategies: Results from a qualitative study

Pakyz

Moczygemba

VanderWielen

et al. 2014

American Journal of Infection Control

115

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“…Future research should explore how leaders and staff at microbiology laboratories perceive the interaction with clinicians, as a basis for possible interventions on these lines of communication. Furthermore, studies show that antimicrobial stewardship teams can decrease time to appropriate therapy by close follow up of microbiological test results [30, 31], so establishing such teams in Norwegian hospitals is highly relevant.…”

Section: Discussionmentioning

confidence: 99%

An antimicrobial stewardship program initiative: a qualitative study on prescribing practices among hospital doctors

Skodvin

Aase

Charani

et al. 2015

Antimicrob Resist Infect Control

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BackgroundNorway has a low, but increasing prevalence of resistance and few antimicrobial stewardship initiatives. When developing stewardship interventions, an understanding of the determinants of antimicrobial prescribing is needed. We report on the first qualitative study investigating factors influencing doctors’ antimicrobial prescribing practices in Norwegian hospitals.MethodsQualitative semi-structured interviews were conducted with 15 Norwegian hospital doctors prescribing antimicrobials to adult patients. Interviews were transcribed verbatim and thematic analysis was applied to analyse the data.ResultsColleagues, in particular infectious disease specialists, microbiology test results and the newly published national guideline on antimicrobials were identified as key factors influencing antimicrobial prescribing practices. Delayed availability was a barrier for the utilization of microbiology test results and increasing clinical experience overrides the influence of the national guideline.Patient assessment, informal training by experienced colleagues, and infectious disease specialists replacing managers in promoting prudent prescribing policies, also influenced prescribing practices.ConclusionThis study identified the following contextual factors that need to be addressed when developing antimicrobial stewardship programs in Norway: a common work practice for seeking collegial advice, logistics of microbiology test results, and formal leadership and systematic training on prudence. Other countries initiating stewardship programmes may benefit from performing a similar mapping of facilitators and barriers, to identify important stakeholders and organisational obstacles, before developing sustainable and tailored antimicrobial stewardship interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-015-0065-4) contains supplementary material, which is available to authorized users.

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Automated Alerts Coupled with Antimicrobial Stewardship Intervention Lead to Decreases in Length of Stay in Patients with Gram-Negative Bacteremia

Abstract: Active alerting coupled with stewardship intervention in patients with gram-negative bacteremia positively impacted time to appropriate therapy, length of stay, and mortality and should be a target of antimicrobial stewardship programs.

Cited by 53 publications

References 11 publications

Clinical Impact of Laboratory Implementation of Verigene BC-GN Microarray-Based Assay for Detection of Gram-Negative Bacteria in Positive Blood Cultures

Clinical Impact of Laboratory Implementation of Verigene BC-GN Microarray-Based Assay for Detection of Gram-Negative Bacteria in Positive Blood Cultures

Facilitators and barriers to implementing antimicrobial stewardship strategies: Results from a qualitative study

An antimicrobial stewardship program initiative: a qualitative study on prescribing practices among hospital doctors

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