Improving outcomes and antibiotic stewardship (IOAS) for patients with Gram-positive bloodstream infections through use of rapid testing: a quasi-experimental multicentre study of the Accelerate PhenoTest™ BC Kit

Abstract

Background Data from the Improving Outcomes and Antibiotic Stewardship for Patients with Bloodstream Infections: Accelerate PhenoTest™ BC Kit (AXDX) Registry Study were analysed to determine the impact of rapid organism identification and antimicrobial susceptibility testing (AST) for Gram-positive bacteraemia. Patients and methods This multicentre, quasi-experimental study evaluated clinical and antimicrobial stewardship metrics following the implementation of AXDX. Data from hospitalized patients with bacteraemia were compared between groups, one that underwent testing on AXDX (post-AXDX) and one that underwent traditional identification and AST (pre-AXDX). An analysis of patients with Gram-positive bacteraemia was performed. The primary outcome was time to optimal therapy (TTOT). Secondary outcomes included time to first antibiotic modification (overall and Gram-positive), duration of unnecessary MRSA coverage, incidence of adverse events, length of stay and mortality. Results A total of 219 (109 pre-AXDX, 110 post-AXDX) patients with Gram-positive bacteraemia were included. Median TTOT was 36.3 h (IQR, 16.9–56.7) in the pre-AXDX group and 20.4 h (IQR, 7.5–36.7) in the post-AXDX group (P = 0.01). Compared with pre-AXDX, median time to first antibiotic modification (29.1 versus 15.9 h; P = 0.002), time to first Gram-positive antibiotic modification (33.2 versus 17.2 h; P = 0.003) and median duration of unnecessary MRSA coverage (58.4 versus 29.7 h; P = 0.04) were reduced post-AXDX. A trend towards decreased acute kidney injury (24% versus 13%; P = 0.06) was observed in the post-AXDX group. Groups did not differ in other secondary outcomes. Conclusions Implementation of AXDX testing for patients with Gram-positive bacteraemia shortened the TTOT and reduced unnecessary antibiotic exposure due to faster antibiotic modifications.

Impact of phenotypic rapid diagnostic assay on duration of empiric antibiotics for gram-negative bacteremia

“…These studies demonstrated an improvement in antimicrobial stewardship measures, primarily in the time to directed therapy. Banerjee et al 19 found a faster median time to first antibiotic modification, and MacVane et al 14 concluded that RDT had an improved the time to optimal therapy, both of which are consistent with our findings. Babowitz et al 11 analyzed the RDT and found A positive culture from another source (ie, urine, tissue, body fluid) which had final results prior to or within 24 h of final blood-culture results.…”

“…For example, one study demonstrated similar improvements in stewardship outcomes, but no significant improvement in clinical outcomes such as length of stay (LOS), CDI or mortality. 14 Another study reported similar results but also illustrated the potential for erroneous results, suggesting that other antimicrobial stewardship (AMS) measures must be used concomitantly. 15 The phenotypic RDT implemented at our institution is the Accelerate PhenoTest (Accelerate Diagnostics, Tucxon, AZ), a rapid phenotypic diagnostic instrument used to identify microorganisms in blood samples in <2 hours and provides antimicrobial susceptibility results in ∼7 hours.…”

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

“…As was the experience at our institution, previous studies have demonstrated that implementation of the Accelerate Pheno system improves time to optimal antimicrobial therapy, particularly when paired with ASP review. [6][7][8] However, an opportunity remained to ensure that patients were at least on an active antimicrobial based on the results of the Accelerate Pheno system in the hours that the ASP team was not in house to review results in real time.…”

“…5 Our clinical microbiology laboratory implemented Accelerate Pheno in September 2018 with real-time intervention by the ASP during standard workday hours, leading to decreased time to optimal therapy. 6,7 We identified an opportunity to further improve patient care by reducing delays in initiation of active antimicrobial therapy outside regular ASP work hours. In this study, we evaluated the impact of incorporating 24-hour unit-based pharmacist review of rapid blood-culture results.…”

Approaches to Reduce Use and Duration of Anti-MRSA Agents for Antimicrobial Stewardship Programs: A Review of Recent Literature

“…Rapid technologies With and Without ASP Interventions and Effect on Anti-MRSA Treatments [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][73][74][75][76][77][78]. …”