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.

We assessed the effectiveness of a Lactobacillus probiotic on rates of health care facility–onset Clostridium difficile infection (HO-CDI) in patients receiving antibiotics. A total of 1576 patients were evaluated. There was no difference in the HO-CDI incidence between those who received probiotics and those who did not (1.8% vs 0.9%; P = .16).

Summary Many isolates of meticillin-resistant Staphylococcus aureus (MRSA) are indistinguishable when compared using the standard pulsed-field gel electrophoresis (PFGE) typing method. This may present a problem when investigating local outbreaks of MRSA transmission in a healthcare setting. It also impedes investigation of the widely disseminated community-acquired MRSA (USA 300-0114) in the inpatient setting, which is displacing other traditional hospital-acquired PFGE types. Combination of methods, including multiple-locus sequence typing (MLST), spa typing and staphylococcal cassette chromosome mec (SCCmec) typing, have been used with, or in place of, PFGE to characterise MRSA for epidemiological purposes. These methods are technically challenging, time-consuming and expensive and are rarely feasible except in large laboratories in tertiary care medical centres. Another method, which is simpler and with faster turnaround time, is multiple-locus variable-number tandem-repeat analysis (MLVA). We investigated the utility of MLVA to distinguish common PFGE types. The results suggest that MLVA can be used to identify unrelated strains with identical PFGE patterns or confirm close genetic composition of linked isolates. MLVA could potentially be used in conjunction with PFGE to validate relationships, but further prospective evaluation of these relationships will be required in order to define the proper role, if any, for use of this method in hospital epidemiology.

Background Rapid identification of gram‐negative bacteremia can improve time to effective antibiotic therapy and antibiotic de‐escalation; however, there are little data that quantify the change in antibiotic utilization. This study evaluates the impact of the Verigene gram‐negative blood culture test (BC‐GN) in combination with an antimicrobial stewardship team (AST) intervention on antipseudomonal (AP) antibiotic utilization in a community hospital system among infections where AP antibiotics are not necessary. Methods This multicenter, pre‐post, quasi‐experimental pilot study was conducted at Scripps Health in San Diego, California. Internal antibiogram data was reviewed, and among the 4 targets of Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, and Proteus species (that lacked resistance genes) detected by the BC‐GN test, antimicrobial sensitivities did not warrant therapy with AP antibiotics. The BC‐GN test was performed at each site where clinical pharmacists notified physicians of results and assisted with antibiotic modifications. The primary end point was AP vs non‐AP antibiotic consumption within the first 5 days of admission. This was measured by days of therapy per patient day (DOT/PD). Secondary end points included hospital and intensive care unit (ICU) length of stay (LOS) and mortality. Results A total of 1051 patients were included; 512 in the pre‐intervention group, and 539 in the intervention group. Compared with the pre‐intervention group, AP antibiotic consumption significantly decreased (0.4 vs 0.2 DOT/PD, P < .0001) and non‐AP antibiotic consumption significantly increased (0.6 vs 0.8 DOT/PD, P < .0001) in the intervention group. Overall median LOS was 5 days vs 5 days (P = .85) and median ICU LOS was 3 days vs 2 days (P = .12), in the pre‐intervention and intervention groups, respectively. Mortality was similar between groups (7.0% vs 5.2% in the pre‐intervention and intervention groups, P = .21). Conclusion Rapid identification of gram‐negative bacteremia with AST intervention decreased AP antibiotic consumption among infections caused by pathogens where AP coverage is not needed.

BackgroundThere is conflicting clinical data regarding the efficacy of probiotics to prevent Clostridium difficile infection (CDI). The goal of this study is to compare rates of hospital acquired Clostridium difficile infection (HA-CDI) among patients receiving antibiotics with or without concomitant administration of probiotics.MethodsThis retrospective, cohort study compares hospitalized patients who received antibiotics alone vs. antibiotics plus a multi-strain probiotic preparation of lactobacillus over a six month time period. Probiotics were given at the discretion of the physician. The primary outcome was incidence in HA-CDI (defined as onset after hospital day three) between groups.ResultsA total of 1,576 patients met selection criteria, with 927 patients receiving antibiotics alone and 649 patients receiving antibiotics plus probiotics. HA-CDI rates were 0.9% and 1.8% (P = 0.16), respectively. In a subgroup analysis of patients in the antibiotic only group, patients who received similar antibiotic exposure as the probiotics group (n = 284) had no difference in rates of HA-CDI (1.8% vs. 1.8%; P = 1.0).ConclusionProbiotic administration did not decrease rates of HA-CDI in our institution. We recommend prioritizing resources to other CDI reduction measures such as decreasing antibiotic exposure and preventing transmission.Disclosures All authors: No reported disclosures.