Impact of Antimicrobial Stewardship and Rapid Microarray Testing on Patients With Gram-Negative Bacteremia

Rivard, Kaitlyn; Athans, Vasilios; Lam, Simon W.; Gordon, Steven M.; Procop, Gary W.; Richter, Sandra; Neuner, Elizabeth

doi:10.1093/ofid/ofw194.11

Cited by 18 publications

(31 citation statements)

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“…The available evidence suggests that combining RDTs with effective ASPs facilitates stewardship implementation at the hospital level and can be associated with improvements in clinical outcomes including mortality and length of stay. [81][82][83][84][85][86][87] Similar findings have been observed with RDTs and ASPs for fungal infections. [88][89][90] Currently, the greatest challenge to ICU clinicians is effective management of multidrug-resistant GNB infections.…”

Section: Evidence In Support Of the Use Of Rdts To Optimize Antibiotisupporting

confidence: 77%

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Guillamet

Burnham

Kollef

2019

Semin Respir Crit Care Med

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Antibiotic resistance is recognized as a key determinant of outcome in patients with serious infections influencing empiric antibiotic practices especially for critically ill patients. Within the intensive care unit (ICU), nosocomial infections and increasingly community-onset infections are caused by multidrug-resistant bacteria. Escalating rates of antibiotic resistance adds substantially to the morbidity, mortality, and cost related to infections treated in the ICU. Both gram-positive organisms, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, and gram-negative bacteria, including Pseudomonas aeruginosa, Acinetobacter species, carbapenem-resistant Enterobacteriaceae, and extended spectrum β-lactamase producing organisms, are urgent threats. The rising rates of antimicrobial resistance have resulted in routine empiric administration of broad-spectrum antibiotics by clinicians to critically ill patients even when bacterial infection is microbiologically absent. Moreover, new broad-spectrum antibiotics are a challenge to use effectively while avoiding emergence of further resistance. Use of rapid diagnostic technologies (RDTs) will likely provide an important methodology for achieving this important balance. There is an urgent need for integrating the administration of new and existing antibiotics with RDTs in a way that is safe, cost-effective, applicable in all countries, and sustainable.

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Section: Evidence In Support Of the Use Of Rdts To Optimize Antibiotisupporting

confidence: 77%

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Guillamet

Burnham

Kollef

2019

Semin Respir Crit Care Med

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“…Timely initiation of appropriate antimicrobial therapy is crucial for optimal management of bacteremia and sepsis. The use of rapid molecular assays and mass spectrometry to rapidly identify bacterial species in blood specimens has been consistently shown to decrease the time to appropriate antimicrobial therapy, mortality, and morbidity and hospital costs MacVane and Nolte, 2016;Bookstaver et al, 2017;Pogue et al, 2018;Rivard et al, 2017;Walker et al, 2016;Perez et al, 2013). A recent meta-analysis evaluated 31 observational bloodstream infection studies comparing clinical outcomes between molecular rapid diagnostic tests (RDTs) and conventional microbiological methods for organism identification (Timbrook et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

The Impact of Integrating Rapid PCR-Based Blood Culture Identification Panel to an Established Antimicrobial Stewardship Program in the United Arab of Emirates

Nasef

Lababidi

Alatoom

et al. 2020

International Journal of Infectious Diseases

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Background: Studies have shown improvement in the outcome of blood stream infections (BSI) due to the use of Rapid PCR-Based Blood Culture Identification Panel (BCID) in Antimicrobial stewardship programs (ASP). There is currently no data on the use of BCID with ASP in the United Arab Emirates (UAE). Method: Pre-post quasiexperimental study included hospitalized patients with BSI, their positive blood cultures on BCID were studied in 2 groups: conventional culture with ASP (AS), and BCID with ASP (BCID). The primary outcomes were time to first appropriate antimicrobial therapy, infection related length of stay (LOS), ICU admission, 14 days bacteremia recurrence and in-hospital mortality. Secondary outcomes were 30 days reinfection rate, hospital cost and ASP interventions. Results: Out of total 477 positive blood cultures, 206 (AS and BCID) with real BSI were included. The time needed for organism identification was shorter in the BCID group than in the AS group (1.3 h vs. 51 h; P = 0.0002). BCID had a shorter time to appropriate antimicrobial therapy than AS (17.8 h vs.45 h; P = 0.0004). No statistical difference was observed in mortality rate, 14 days bacteremia recurrence, ICU admission, hospital cost, LOS or ASP interventions. Conclusion: Implementing BCID to ASP significantly decreased the time needed to identify the organism and time to appropriate antimicrobial therapy. Similarly, LOS and hospital cost were reduced, however, the reduction was not statistically significant.

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“…Diagnostic tests designed to screen CRE for specific carbapenemase enzymes from clinical specimens represent promising tools when used in conjunction with AMS interventions. Previous studies showed that molecular tests could rapidly detect GNB infections, direct appropriate choice for early antibiotic therapy, and improve patient outcomes [25,26].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…MBL, KPC) and is not protected by tazobactam. Clinical efficacy of ceftozolane-tazobactam has been demonstrated in the treatment of cUTI and abdominal infections, although the number of patients infected with P. aeruginosa in the studies was limited [26,114,138].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Antimicrobial treatment challenges in the era of carbapenem resistance

Peri

Doi

Potoski

et al. 2019

Diagnostic Microbiology and Infectious Disease

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Impact of Antimicrobial Stewardship and Rapid Microarray Testing on Patients With Gram-Negative Bacteremia

Cited by 18 publications

References 0 publications

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

The Impact of Integrating Rapid PCR-Based Blood Culture Identification Panel to an Established Antimicrobial Stewardship Program in the United Arab of Emirates

Antimicrobial treatment challenges in the era of carbapenem resistance

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