Development and Validation of a Decision-Making Stratification Algorithm to Optimize the Use of Rapid Diagnostic Testing for Patients with Staphylococcus Bacteremia

Abstract

Purpose To evaluate whether introducing rapid diagnostic testing in conjunction with implementing a stratification algorithm for testing eligibility would be an appropriate clinical and cost saving approach. Method An internal concurrent 4-month observational study was performed. Positive blood cultures continued to be worked up in accordance with standard of care. An additional call to the infectious disease (ID) pharmacy service occurred for all positive blood cultures with Gram-positive cocci in clusters (GPCC). The ID pharmacy service investigated each case using a prespecified stratification algorithm to minimize unnecessary use of rapid identification testing. Results 43 patients with GPCC were screened. Only nine patients met inclusion criteria for QuickFISH™ testing. The average expected time avoided to optimize antibiotic therapy is 35 ± 16 hours. If the QuickFISH test had been indiscriminately implemented for all cases, the cost for performing this test would have been $5,590. However, using the prespecified algorithm, only 9 patients were tested for a projected cost of $1,170. Conclusion Introducing rapid diagnostic testing in conjunction with implementing patient stratification algorithm for rapid identification of GPCC from blood cultures in addition to the ID pharmacy intervention will provide a positive impact on the clinical and economic outcomes in our health care setting.

Prescribing errors among adult patients in a large tertiary care system in Saudi Arabia

“…This could explain the emergence of antimicrobial resistance observed in hospitals and supports the desperate need to establish antimicrobial stewardship programs and recruit infectious disease clinical pharmacists. 35 , 36 Omeprazole was the most individual drug associated with PEs, despite its safety profile and controversy over excessive prescription by physicians. Reports have shown that the rate of inappropriate prescribing of proton pump inhibitors for stress ulcer prophylaxis could reach up to 71%, which has been attributed to prescribing physician ignorance of proper indications and its side effects such as Clostridium difficile infections.…”

Evaluation of QuickFISH and maldi Sepsityper for identification of bacteria in bloodstream infection

“…A recent review has shown that the use of rapid diagnostic tests such as the PNA-FISH is a cost-effective strategy that was associated with high therapeutic effectiveness and health care cost savings [40]. In addition, it has been demonstrated that direct identification of organism in positive blood cultures bottles using MALDI-TOF MS or QuickFISH V R may have a clinical impact in patients with bacteraemia and improve appropriateness of antibiotic therapy [10,[41][42][43].…”

Regulating antimicrobial sales in Saudi Arabia: Achievements and challenges

“…It is estimated that AMR would cause 10 million deaths by 2050 5 . The AMR crisis has necessitated global efforts to implement containment measures to reduce antibiotic consumption and utilise current resources wisely and efficiently 6‐10 …”

“…5 The AMR crisis has necessitated global efforts to implement containment measures to reduce antibiotic consumption and utilise current resources wisely and efficiently. [6][7][8][9][10] The analyses of pharmaceutical sales data from 71 countries revealed an increase by 36% in antimicrobial consumption between…”