Outcomes of Rapid Identification for Gram-Positive Bacteremia in Combination with Antibiotic Stewardship at a Community-Based Hospital System

Abstract

Background Rapid diagnostics for bloodstream infections have been shown to improve outcomes. Most studies have focused on rapid diagnostics for a single pathogen and have been conducted in academic medical centers. The Verigene Gram‐Positive Blood Culture Test (BC‐GP) identifies 12 gram‐positive organisms and 3 genetic markers of antibiotic resistance from positive blood culture media in 2.5 hours. This study evaluates implementation of the Verigene BC‐GP panel in combination with real‐time support from the Antibiotic Stewardship Team (AST) in a community hospital system. Methods This multicenter, pre‐post, quasi‐experimental study was conducted at the five hospitals that compose Scripps Healthcare. Rapid diagnostic testing was performed at a central laboratory from 7 a.m.–7 p.m. Pharmacists notified physicians of results and assisted with antibiotic modifications. The primary outcomes were average time to targeted antibiotic therapy and difference in antibiotic duration for contaminants. Secondary end points included hospital length of stay, mortality, pharmacy costs, and overall hospitalization costs. Adult patients with a gram‐positive bacteremia admitted in 2011 (pre‐rapid testing) were compared with those admitted in 2014 (post‐rapid testing). Results There were 103 patients in the preintervention group and 64 patients in the intervention group. The optimized identification process, combined with AST intervention, improved mean time to targeted antibiotic therapy (61.1 vs 35.4 hrs, p<0.001) and decreased mean duration of antibiotic therapy for blood culture contaminants (42.3 vs 24.5 hrs, p=0.03). Median length of stay (9.1 vs 7.2 days, p=0.04) and overall median hospitalization costs ($17,530 vs $10,290, p=0.04) were lower in the intervention group. Mortality was similar between groups (9.1% vs 9.2%, p=0.98). Conclusion Rapid identification of gram‐positive blood cultures with AST intervention decreased time to targeted antibiotic therapy, length of unnecessary antibiotic therapy for blood culture contaminants, length of stay, and overall hospital costs.

Rapid identification of gram‐negative bacteremia and impact on antipseudomonal antibiotic consumption with antimicrobial stewardship at a community hospital system

“…As physicians became more familiar with the gram‐negative rapid diagnostic technology, notification workflow, and antibiogram susceptibilities, it is possible that this influenced empiric antibiotic selection and led to less empiric prescribing of AP antibiotics. This study also shared some commonalities with our previous experience with rapid diagnostics for gram‐positive bacteremia . First, this study adds to the literature of demonstrating favorable patient outcomes using rapid diagnostics in a community hospital setting.…”

“…This strategy may be especially helpful in hospitals with fewer dedicated resources to antibiotic stewardship. Finally, our findings reiterate that rapid diagnostics with AST intervention can make an impact on patient care in hospitals where resources are not available to provide continuous 24‐hour notification …”

Impact of rapid identification of positive blood cultures using the Verigene system on antibiotic prescriptions: A prospective study of community-onset bacteremia in a tertiary hospital in Japan

“…In this study, we included only patients with at least two sets of positive blood cultures to exclude contamination of GP bacteremia, and to maximize the inclusion of patients with bacteremia due to “true infection.” The inclusion of patients with one set of positive blood cultures for GP bacteremia may have revealed additional benefits of the rapid identification tests for pathogens of bacteremia, including the Verigene BC-GP test, such as an increase in the discontinuation of unnecessary antibiotics against COB [15] and reductions in the time in the intensive care unit, the total cost of care by the differentiation of coagulase-negative Staphylococcus and S . aureus [15,16], and the 30-day mortality by the differentiation of E .…”

A Stewardship Approach To Optimize Antimicrobial Therapy through Use of a Rapid Microarray Assay on Blood Cultures Positive for Gram-Negative Bacteria

“…Molecular diagnostic assays can produce results faster than traditional identification and susceptibility testing methods and may help decrease the time to appropriate antimicrobial therapy (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The Verigene Gram-negative blood culture (BC-GN) assay (Nanosphere, Inc., Northbrook, IL) is a qualitative in vitro diagnostic test for the rapid detection and identification of select Gram-negative bacteria and resistance markers (17).…”