Impact of Pharmacist Involvement on the Utility of a Gram-Negative Blood Culture Identification Panel on Antimicrobial Usage

Abstract

Background: A rapid molecular diagnostic test (MDT) is a test used to identify several different species of gram-negative bacteria and their genetic resistance markers. However, the impact of rapid MDT has not been established when combined with pharmacist involvement. Objective: To determine the impact of pharmacy involvement on patient outcomes when using rapid MDT. The primary outcome is the time from gram stain result to the first dose of the targeted antibiotic. Methods: This is a single-center, quasi-experimental, 1-group pretest-posttest design study of patients with gram-negative bacteremia in a community hospital. Hospitalized patients 18 years or older were included if they had a gram-negative blood culture. Patients were excluded if they were discharged or expired prior to culture results. Outcomes were compared between patients prior to and after implementation of the automated MDT. This research was determined to be exempt from institutional review board oversight consistent with West Florida Healthcare and in accordance with institutional policy. Results: The use of rapid MDT combined with pharmacist intervention resulted in a statistically significant decrease in the time to targeted antibiotic therapy (pre-intervention group, n = 77, 44.8 ± 17.8 hours versus post-intervention group, n= 80, 4.4 ± 5.8 hours; P ≤.001). There was no significant difference found between secondary outcomes. Limitations included small sample size as well as inconsistent documentation. Conclusions: The use of rapid MDT combined with pharmacist intervention resulted in a statistically significant decrease in the time to targeted antibiotic therapy.

Impact on time to active antimicrobial therapy with 24-hour pharmacist review of Accelerate Pheno BC Kit results

“…Other studies have similarly concluded that pharmacist incorporation in assessment of blood-culture results can be helpful; however, this study is the first to focus on improving delayed initiation of active antimicrobial therapy with the Accelerate Pheno system through a pharmacist-led mechanism. 9,10 This study had several limitations. We identified the potential for maturation effect secondary to the stewardship team making recommendations during standard workday hours prior to the postimplementation phase (and during it) as well as the potential for unmeasured confounders.…”

Impact of Gram-Negative Rod Bacteremia Rapid Diagnostic Testing and Real-Time Clinical Pharmacist Intervention

“…The limited literature available for GNR bacteremia focuses on RDT implementation with specialized services such as Antimicrobial Stewardship (AMS) physicians or pharmacists during limited hours. [2][3][4][5][6][7] To our knowledge, there is no data available regarding the impact of around-the-clock, real-time decentralized clinical pharmacist review on RDT results for GNR bacteremia.…”

“…5 Similarly, Bowman et al assessed the impact of RDT plus pharmacist evaluation around-the-clock, however their RDT review was performed by an AMS pharmacist during weekday hours and non-AMS pharmacists after hours. 6 Lastly, Robinson et al RDT results were reviewed exclusively by AMS team members. 7 This study contributes to current literature on RDT implementation in GNR bacteremia which is less robust than data for gram-positive bacteremia.…”