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. 2020 Sep 12;7(10):ofaa427.
doi: 10.1093/ofid/ofaa427. eCollection 2020 Oct.

Management of Gram-Negative Bloodstream Infections in the Era of Rapid Diagnostic Testing: Impact With and Without Antibiotic Stewardship

Kimberly C Claeys  1 , Emily L Heil  1 , Stephanie Hitchcock  2 , J Kristie Johnson  2 , Surbhi Leekha  2   3
Affiliations

Management of Gram-Negative Bloodstream Infections in the Era of Rapid Diagnostic Testing: Impact With and Without Antibiotic Stewardship

Kimberly C Claeys et al. Open Forum Infect Dis. .

Abstract

Background: Verigene Blood-Culture Gram-Negative is a rapid diagnostic test (RDT) that detects gram-negatives (GNs) and resistance within hours from gram stain. The majority of the data support the use of RDTs with antimicrobial stewardship (AMS) intervention in gram-positive bloodstream infection (BSI). Less is known about GN BSI.

Methods: This was a retrospective quasi-experimental (nonrandomized) study of adult patients with RDT-target GN BSI comparing patients pre-RDT/AMS vs post-RDT/pre-AMS vs post-RDT/AMS. Optimal therapy was defined as appropriate coverage with the narrowest spectrum, accounting for source and co-infecting organisms. Time to optimal therapy was analyzed using Kaplan-Meier and multivariable Cox proportional hazards regression.

Results: Eight-hundred thirty-two patients were included; 237 pre-RDT/AMS vs 308 post-RDT/pre-AMS vs 237 post-RDT/AMS, respectively. The proportion of patients on optimal antibiotic therapy increased with each intervention (66.5% vs 78.9% vs 83.2%; P < .0001). Time to optimal therapy (interquartile range) decreased with introduction of RDT: 47 (7.9-67.7) hours vs 24.9 (12.4-55.2) hours vs 26.5 (10.3-66.5) hours (P = .09). Using multivariable modeling, infectious diseases (ID) consult was an effect modifier. Within the ID consult stratum, controlling for source and ICU stay, compared with the pre-RDT/AMS group, both post-RDT/pre-AMS (adjusted hazard ratio [aHR], 1.34; 95% CI, 1.04-1.72) and post-RDT/AMS (aHR, 1.28; 95% CI, 1.01-1.64), improved time to optimal therapy. This effect was not seen in the stratum without ID consult.

Conclusions: With the introduction of RDT and AMS, both proportion and time to optimal antibiotic therapy improved, especially among those with an existing ID consult. This study highlights the beneficial role of RDTs in GN BSI.

Keywords: antimicrobial stewardhip; gram-negative bloodstream infection; rapid diagnostic testing.

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Figures

Figure 1.
Figure 1.
 Schematic of University of Maryland Medical Center Gram-negative Rapid Diagnostic Treatment Pathway with roles and responsibilities of inter-disciplinary team members. Abbreviations: AMS, antimicrobial stewardship; AST, automated susceptibility testing; EMR, electronic medical record; ID, infectious diseases; RDT, rapid diagnostic test.
Figure 2.
Figure 2.
Kaplan-Meier cumulative probability of receipt of optimal therapy by group. Abbreviations: AMS, antimicrobial stewardship; RDT, rapid diagnostic test.
Figure 3.
Figure 3.
Interrupted time series analysis of trends in time to optimal therapy by group. Abbreviations: AMS, antimicrobial stewardship; RDT, rapid diagnostic test.
See this image and copyright information in PMC

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References

    1. Goto M, Al-Hasan MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect 2013; 19:501–9. - PubMed
    1. Centers for Disease Control and Prevention. The biggest antibiotic-resistant threats in the U.S. Centers for Disease Control and Prevention. 2018 Available at: https://www.cdc.gov/drugresistance/biggest_threats.html. Accessed 24 February 2019.
    1. Marquet K, Liesenborgs A, Bergs J, et al. Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis. Crit Care 2015; 19:63. - PMC - PubMed
    1. Lodise TP, Zhao Q, Fahrbach K, et al. A systematic review of the association between delayed appropriate therapy and mortality among patients hospitalized with infections due to Klebsiella pneumoniae or Escherichia coli: how long is too long? BMC Infect Dis 2018; 18:625. - PMC - PubMed
    1. Ibrahim EH, Sherman G, Ward S, et al. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000; 118:146–55. - PubMed