Rapid organism detection of Staphylococcus aureus bacteremia and communication to clinicians expedites antibiotic optimization. We evaluated clinical and economic outcomes of a rapid polymerase chain reaction methicillin‐resistant S. aureus/S. aureus blood culture test (rPCR). This single‐center study compared inpatients with S. aureus bacteremia admitted from 1 September 2008 through 31 December 2008 (pre‐rPCR) and those admitted from 10 March 2009 through 30 June 2009 (post‐rPCR). An infectious diseases pharmacist was contacted with results of the rPCR; effective antibiotics and an infectious diseases consult were recommended. Multivariable regression assessed clinical and economic outcomes of the 156 patients. Mean time to switch from empiric vancomycin to cefazolin or nafcillin in patients with methicillin‐susceptible S. aureus bacteremia was 1.7 days shorter post‐rPCR (P = .002). In the post‐rPCR methicillin‐susceptible and methicillin‐resistant S. aureus groups, the mean length of stay was 6.2 days shorter (P = .07) and the mean hospital costs were $21,387 less (P = .02). rPCR allows rapid differentiation of S. aureus bacteremia, enabling timely, effective therapy and is associated with decreased length of stay and health care costs.

Rapid microbiologic tests provide opportunities for antimicrobial stewardship programs to improve antimicrobial use and clinical and economic outcomes. Standard techniques for identification of organisms require at least 48-72 hours for final results, compared with rapid diagnostic tests that provide final organism identification within hours of growth. Importantly, rapid microbiologic tests are considered "game changers" and represent a significant advancement in the management of infectious diseases. This review focuses on currently available rapid diagnostic tests and, importantly, the impact of rapid testing in combination with antimicrobial stewardship on patient outcomes.

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In an era of escalating resistance and a lack of new antimicrobial discovery, stewardship programs must utilize knowledge of pharmacodynamics to achieve maximal exposure in the treatment of Pseudomonas aeruginosa infections. We evaluated the clinical and economic outcomes associated with extended-infusion cefepime in the treatment of P. aeruginosa infections. This single-center study compared inpatients who received cefepime for bacteremia and/or pneumonia admitted from 1 January 2008 through 30 June 2010 (a 30-min infusion of 2 g every 8 h) to those admitted from 1 July 2010 through 31 May 2011 (a 4-h infusion of 2 g every 8 h). The overall mortality was significantly lower in the group that received extended-infusion treatment (20% versus 3%; P ‫؍‬ 0.03). The mean length of stay was 3.5 days less for patients who received extended infusion (P ‫؍‬ 0.36), and for patients admitted to the intensive care unit the mean length of stay was significantly less in the extended-infusion group (18.5 days versus 8 days; P ‫؍‬ 0.04). Hospital costs were $23,183 less per patient, favoring the extended-infusion treatment group (P ‫؍‬ 0.13). We conclude that extended-infusion treatment with cefepime provides increased clinical and economic benefits in the treatment of invasive P. aeruginosa infections.A ntimicrobial resistance has emerged as a global health crisis, gaining the attention of the World Health Organization and the U.S. Department of Health and Human Services (1). As antimicrobial resistance continues to emerge and new antimicrobial development stagnates, antimicrobial stewardship programs are being implemented worldwide. The goal of antimicrobial stewardship is to optimize antimicrobial therapy with maximal impact on the subsequent development of resistance (2-4). The Healthcare Infection Control Practices Advisory Committee, in partnership with the U.S. Department of Health and Human Services, lists antimicrobial stewardship as a top 5 message for health care workers (5).Pseudomonas aeruginosa infections constitute a tremendous burden on hospitals in the United States in terms of morbidity, mortality, and health care costs. P. aeruginosa infections are associated with a mortality rate of 18 to 60%, and the cost of treatment is substantial, ranging from $20,000 to $80,000 per infection (6-11). Antimicrobial therapy for P. aeruginosa is limited because of the organism's multiple resistance mechanisms, often resulting in higher .Cefepime is a "fourth-generation" cephalosporin with activity against Gram-positive and Gram-negative organisms, including P. aeruginosa. Because of its broad activity, cefepime is used as empirical antibiotic therapy for serious infections, including pneumonia and bacteremia. Like other ␤-lactam antibiotics, cefepime displays time-dependent bactericidal activity, and its efficacy is optimized when free drug concentrations exceed the MIC (fT Ͼ MIC) for at least 60 to 70% of the dosing interval (15-18). Recent evidence suggests that conventional regimens may not attain this fT Ͼ MIC (19-21). ...