Background Verigene Blood-Culture Gram-Negative is a rapid diagnostic test (RDT) that detects GNs and resistance within hours from Gram-stain. The majority of data supports the use of RDTs with antimicrobial stewardship (AMS) intervention in gram-positive BSI; Less is known on for GN BSI. Methods Retrospective quasi-experimental (non-randomized) study of adult patients with RDT-target GN BSI comparing patients pre-RDT/AMS versus post-RDT/pre-AMS versus post-RDT/AMS. Optimal therapy was defined as appropriate coverage with 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 versus 308 post-RDT/pre-AMS versus 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 & 0.0001). Time to optimal therapy decreased with introduction of RDT; 47h (IQR, 7.9, 67.7) vs 24.9h (IQR 12.4, 55.2) vs 26.5h (IQR 10.3, 66.5), P = 0.09. Using multivariable modelling, ID consult was an effect modifier. Within the ID consult stratum, controlling for source and ICU stay, compared to 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) had 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 therapy optimal antibiotic therapy improved, especially among those with an existing ID consult. This study highlights the beneficial role of RDTs in GN BSI.

Three RDT platforms (Verigene BC-GN, BioFire® BCID, and BCID 2 (RUO)) were compared using the Desirability of Outcome Ranking Management of Antimicrobial Therapy (DOOR -MAT) to evaluate potential downstream antimicrobial prescribing decisions resulting from the panels different organism and resistance detection. BioFire BCID (RUO) had the best mean DOOR-MAT scores.

We describe epidemiologic and microbiologic characteristics of patients co-colonized with different species of carbapenem-resistant Enterobacteriaceae (CRE) from 5 hospitals in 4 states. 28/313 patients (8.9%) were co-colonized with at least 2 different CRE species. Different species within the same patient showed identical mechanism resistance in 18/28 (64%) of cases.

We have examined the draft genomes of 388 methicillin-resistant Staphylococcus aureus isolates obtained from intensive care unit patients at three geographically distributed hospitals to determine genomic diversity associated with potential health care worker-associated transmission.

Interactions with health care workers are often thought to be associated with the spread of microbes in the hospital setting. We have examined the genomic diversity of methicillin-resistant Staphylococcus aureus isolates from the gloves and gowns of health care workers from four hospitals in three states.