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. 2022 Sep 9;11(9):1226.
doi: 10.3390/antibiotics11091226.

Impact of an Antimicrobial Stewardship Program Intervention Associated with the Rapid Identification of Microorganisms by MALDI-TOF and Detection of Resistance Genes in ICU Patients with Gram-Negative Bacteremia

Aléia Faustina Campos  1 , Tiago Arantes  2 , Amanda Magalhães Vilas Boas Cambiais  2 , Ana Paula Cury  3 , Camila Guimarães Tiroli  3 , Flávia Rossi  3 , Luiz Marcelo Sa Malbouisson  4 , Silvia Figueiredo Costa  5 , Thaís Guimarães  1
Affiliations

Impact of an Antimicrobial Stewardship Program Intervention Associated with the Rapid Identification of Microorganisms by MALDI-TOF and Detection of Resistance Genes in ICU Patients with Gram-Negative Bacteremia

Aléia Faustina Campos et al. Antibiotics (Basel). .

Abstract

Combination of strategies for rapid diagnostics tests (RDT) with real-time intervention could improve patient outcomes. We aimed to assess the impact on clinical outcomes, antimicrobial consumption, and costs in patients with gram-negative bacteremia. We designed a quasi-experimental study among 216 episodes of gram-negative bacteremia using RDT (MALDI-TOF and detection of resistance genes) directly from blood culture bottles combined with real-time communication of results. Our study did not demonstrate impact on 30-day mortality (25% vs. 35%; p = 0.115). Hospital and ICU length of stay were significantly lower in the intervention period ((44 days vs. 39 days; p = 0.005) and (17 days vs. 13 days; p = 0.033)), respectively. The antimicrobial consumption was 1381 DOT/1000 days in the pre-intervention period compared to 1262 DOT/1000 days in the intervention period (p = 0.032). Antimicrobials against gram-positive and carbapenems had a significantly reduced consumption in the intervention period. Our intervention showed no impact on 30 days-mortality, but demonstrated an impact on hospital and ICU length of stay, as well as antimicrobials consumption and costs. Knowledge of resistance genes adds value and information for safe decision making that can result in direct and indirect benefits related to the economic burden of antibiotic overuse and bacterial resistance.

Keywords: antimicrobial consumption; antimicrobial stewardship; days of therapy; gram-negative bacteremia; mortality; rapid diagnostics tests.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient selection flowchart.
Figure 2
Figure 2
TAT: Turnaround time between pre-intervention and intervention period. (a): GRAM: time from bacteria detection until Gram stain. (b): MALDI-TOF: time from bacteria detection until MALDI-TOF. (c): PCR: time from bacteria detection until PCR for the intervention group only. (d): AST: time from bacteria detection until antimicrobial susceptibility test. *: Mann–Whitney test.
See this image and copyright information in PMC

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