The impact of rapid diagnostic testing, surveillance software, and clinical pharmacist staffing at a large community hospital in the management of Gram-negative bloodstream infections

Abstract

Rapid diagnostic testing (RDT) combined with an antimicrobial stewardship program (ASP) has shown improved outcomes in bloodstream infections (BSIs). We assessed the impact of RDT, surveillance software, and ASP pharmacist staffing on time to optimal therapy (TOT) in Gram-negative BSIs. Adults with Gram-negative BSIs were included in this retrospective evaluation across 2 study periods. The preimplementation group (n = 121) had longer TOT than the postimplementation group (n = 120) (59.6 ± 36.2 h versus 29.0 ± 24.2 h, P < 0.001). Escalation (51.1 ± 26.4 h versus 16.9 ± 15.7 h, P < 0.001) and de-escalation (63.1 ± 39.5 h versus 39.2 ± 25.6 h, P < 0.01) of therapy were shorter in the postimplementation group. TOT for patients with multidrug-resistant organisms (MDROs) was shorter in the postimplementation group (61.8 ± 37.2 h versus 21.9 ± 18.8 h, P < 0.001). TOT was shorter during fully staffed clinical pharmacist hours (30.6 ± 58.9 h versus 19.7 ± 31.7 h, p = 0.014). Implementation of RDT and surveillance software with an ASP decreased TOT for Gram-negative BSIs, including MDROs.

Keywords: Anti-infective agents; Antimicrobial stewardship; Gram-negative bacteremia; Pharmacy; Rapid diagnostics.