Impact of an Antimicrobial Stewardship Program-bundled initiative utilizing Accelerate Pheno™ system in the management of patients with aerobic Gram-negative bacilli bacteremia

Abstract

Purpose Gram-negative bacteria (GNB) are a leading cause of bloodstream infections (BSI) and management is complicated by antibiotic resistance. The Accelerate Pheno™ system (ACC) can provide rapid organism identification and antimicrobial susceptibility testing (AST). Methods A retrospective, pre-intervention/post-intervention study was conducted to compare management of non-critically ill patients with GNB BSI before and after implementation of a bundled initiative. This bundled initiative included dissemination of a clinical decision algorithm, ACC testing on all GNB isolated from blood cultures, real-time communication of results to the Antimicrobial Stewardship Program (ASP), and prospective audit with feedback by the ASP. The pre-intervention period was January 2018 through December 2018, and the post-intervention period was May 2019 through February 2020. Results Seventy-seven and 129 patients were included in the pre-intervention and post-intervention cohorts, respectively. When compared with the pre-intervention group, the time from Gram stain to AST decreased from 46.1 to 6.9 h (p < 0.001), and the time to definitive therapy (TTDT) improved from 32.6 to 10.5 h (p < 0.001). Implementation led to shorter median total duration of antibiotic therapy (14.2 vs 9.5 days; p < 0.001) and mean hospital length of stay (7.9 vs 5.3 days; p = 0.047) without an increase in 30-day readmissions (22.1% vs 14%; p = 0.13). Conclusion Implementation of an ASP-bundled approach incorporating the ACC aimed at optimizing antibiotic therapy in the management GNB BSI in non-critically ill patients led to reduced TTDT, shorter duration of antibiotic therapy, and shorter hospital length of stay without adversely affecting readmission rates.

Impact of a Multistep Bundles Intervention in the Management and Outcome of Gram-Negative Bloodstream Infections: A Single-Center “Proof-of-Concept” Study

“…This work is in line with recent papers highlighting the importance of identifying additional treatment and diagnostic strategies to improve the outcome of GN-BSIs [ 17 , 21 , 22 ]. Indeed, excluding early targeted antimicrobial therapy and adequate vital support, another widely recognized pivotal aspect to reduce mortality risk includes the identification of potential foci of infection, which should be quickly controlled [ 23 ], while the selection of patients with uncomplicated BSI who can be treated with short-course antimicrobials is crucial to reducing antimicrobial resistance, potential adverse events, and health care costs [ 23 ].…”

Clinical impact of the Accelerate PhenoTest® BC system on patients with Gram-negative bacteremia and high risk of antimicrobial resistance: A prospective before-after implementation study

“…Following the implementation of AXDX, the median time to an AST-oriented bene cial change was 20.4 hours shorter. This nding is with agreement with other studies showing a decrease in the time to laboratory-guided antimicrobial changes and down-escalation of broad-spectrum antimicrobials in various clinical settings (11)(12)(13)(14)18,19,21,22). Of note, in all of these studies ASP was employed.…”

“…A signi cant shortening of TAT times was previously shown after AXDX implementation (2,3,(15)(16)(17)(18)(19)(20)(21)4,5,(9)(10)(11)(12)(13)(14). In studies assessing AXDX clinical impact, the time to identi cation and AST was shorter than the SOC by 11.3-40.7 hours (12)(13)(14)(18)(19)(20)(21). In our study the AST results time was only 16.8 hours shorter, probably because the laboratory work ow supported performing and reading AST results during evening times.…”

“…However, early involvement of these teams in patient care might lead to a better initial appropriateness of empiric treatment, decreasing the potential bene t of rapid AST. For example, Walsh et al reported shorter treatment duration and LOS after the implementation of the AXDX, however the intervention also included reporting of cases of bacteremia to the ASP team, which led to a signi cant increase in the involvement of ID consulting the management of bacteremic patients (21).…”

New evidence for managing Gram-negative bloodstream infections

“…Significant reduction in time to effective therapy, time to definitive therapy, and length of stay were reported using the Accelerate Pheno TM System (APS) (Accelerate Diagnostics, Tuscon, AZ) in two before-after/quasi experimental studies in patients with GNBSI [21,22]. Significant reduction in time to antibiotic modification in the RDT arm vs. the standard of care arm, however with no difference in outcomes in patients with GNBSI, was reported from the RAPIDS-GN randomized trial [23 ▪▪ ].…”