Centralized Communication of Blood Culture Results Leveraging Antimicrobial Stewardship and Rapid Diagnostics

Abstract

Objective This study aimed to determine if integrating antimicrobial stewardship program (ASP) personnel with rapid diagnostic testing resulted in improved outcomes for patients with positive blood cultures. Method Beginning in 2016, Saint Luke’s Health System (SLHS) implemented a new process where all positive blood cultures were communicated to ASP personnel or SLHS pharmacy staff. Pharmacists then became responsible for interpreting results, assessing patient specific information, and subsequently relaying culture and treatment information to providers. This was a multisite, pre-post, quasi-experimental study (Pre: August to December 2014; Post: August to December 2016). Patients 18 years of age and older with a positive blood culture during admission were included (2014, n = 218; 2016, n = 286). Coprimary outcomes of time to optimal and appropriate therapy were determined from time of culture positivity via gram stain. Secondary outcomes focused on clinical, process, and fiscal endpoints. A pre-post intervention physician survey was conducted to assess the impact on antimicrobial decision making and perceived effect on patient outcomes. Results There was no difference in time to appropriate therapy groups (P = .079). Time to optimal therapy was 9.2 hours shorter in 2016 (P = .004). Provider surveys indicated the process improved communication among clinicians and facilitated a shared decision-making process with a perceived improvement in patient care. Conclusions An ASP-led blood culture communication process for patients with positive blood cultures was shown to improve time to optimal therapy, support physicians in their decision making on critical lab data, and improve the care for hospitalized patients.

Behavior-change interventions to improve antimicrobial stewardship in human health, animal health, and livestock agriculture: A systematic review

“…We extracted clinical outcome data from 57 of 301 total studies ( Fig 7 ). Of three studies that reported the proportion of patients who were admitted to the intensive care unit before and after the intervention, only one reported a statistically significant change, a decrease from 44.5% to 35.5% of patients (OR: 0.7, 95% CI: 0.5–1.0) [ 46 ]. Three separate studies reported the proportion of patients who experienced an adverse event before and after the intervention, and one reported a statistically significant change, an increase from 1.1% to 10.0% (OR: 9.9, 95% CI: 8.4–11.6) [ 47 ].…”

Behavior-change interventions to improve antimicrobial stewardship in human health, animal health, and livestock agriculture: A systematic review

“…We extracted clinical outcome data from 57 of 301 total studies (Fig 6). Of three studies that reported the proportion of patients who were admitted to the intensive care unit before and after the intervention, only one reported a statistically significant change, a decrease from 44.5% to 35.5% of patients (OR: 0.7, 95% CI: 0.5-1.0) (44). Three separate studies reported the proportion of patients who experienced an adverse event before and after the intervention, and one reported a statistically significant change, an increase from 1.1% to 10.0% (OR: 9.9, 95% CI: 8.4-11.6) (45).…”

Bloodstream infections – etiology and current microbiological diagnostics

“…13 Moreover, the result is obtained in a much shorter period of time than in culture and is not influenced by antibiotic therapy. 15 Furthermore, in contrast to the blood culture, which is a qualitative technique, molecular techniques also allow quantitative evaluation of the sample. However, the range of commercial assays for direct testing of blood samples is limited to a few PCR tests belonging to the multiplex group or broad-range assays.…”

“…For identification of the microorganisms -sequencing, mass spectrometry (PCR/ESI-MS) or melting curve analysis (real-time PCR) may be used. 13,15 Multiplex panels enable detection of 20-34 different pathogens and single resistance genes (mainly mecA), and the result may be available within one to several hours. Systems from the group of broad-range PCR have much wider possibilities of microorganism identification, even more than 700 species, and some of them enable identification of dangerous resistance genes (mecA, vanA, vanB, bla KPC ).…”

“…With the use of one of the commercial platforms, it is possible to detect 19 specific species of bacteria, 5 species of yeasts and 3 resistance genes. 15 There is also a possibility of inhibition of a PCR reaction by factors present in the full blood and a small number of microorganisms in the sample volume. In both cases it may lead to falsely-negative results.…”