Impact of Rapid Organism Identification via Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Combined With Antimicrobial Stewardship Team Intervention in Adult Patients With Bacteremia and Candidemia

Huang, Angela; Newton, Duane W.; Kunapuli, Anjly; Gandhi, Tejal; Washer, Laraine; Isip, Jacqueline; Collins, Curtis D.; Nagel, Jerod

doi:10.1093/cid/cit498

Cited by 470 publications

(393 citation statements)

References 19 publications

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“…85 CDSSs can take many forms, including comprehensive computerized disease management systems that can integrate clinical data, medication orders, and laboratory and microbiology results to suggest anti-infective therapy and alert clinicians about potential suboptimal management of infections. [86][87][88][89] Several studies of rapid blood culture diagnostics report favorable outcomes when rapid test results are reported together with CDSSs that provide actionable guidance for clinicians through antimicrobial stewardship team oversight [90][91][92][93][94][95][96][97] or even templated comments contained within the result report. 84 Increasingly, electronic health records platforms such as Epic and Cerner are incorporating CDSSs to enhance antimicrobial stewardship.…”

Section: Treatment Implications Of Rapid Detection Of Crementioning

confidence: 99%

Clinical and laboratory considerations for the rapid detection of carbapenem-resistant Enterobacteriaceae

Banerjee

Humphries

2016

Virulence

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Carbapenem resistance among the Enterobacteriaceae has become a significant clinical and public health dilemma. Rapid administration of effective antimicrobials and implementation of supplemental infection control practices is required to both improve patient outcomes and limit the spread of these highly resistant organisms. However, carbapenem-resistant Enterobacteriaceae (CRE)-infected patients are predominantly identified by routine culture methods, which take days to perform. Rapid genomic and phenotypic methods are currently available to accelerate the identification of carbapenemaseproducing CRE. Effective use of these technologies is reliant on close collaboration between clinical microbiology, infection prevention, antimicrobial stewardship and infectious diseases specialists. This review discusses the performance characteristics of these technologies to date, and describes strategies for their optimal implementation.

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Section: Treatment Implications Of Rapid Detection Of Crementioning

confidence: 99%

Clinical and laboratory considerations for the rapid detection of carbapenem-resistant Enterobacteriaceae

Banerjee

Humphries

2016

Virulence

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“…These effects are more pronounced in patients with BSI where use of rapid diagnostics coupled with pharmacy intervention to improve antibiotic optimization resulted in significant reductions in hospital length of stay (LOS), healthcare costs, and mortality. [8][9][10][11][12][13] To date, the role of rapid diagnostics in ASPs has largely been studied in tertiary or quaternary care medical centers with dedicated infectious diseases pharmacists, complex patient populations, and robust clinical laboratory services. Thus, limited data are available in lower acuity community hospital settings.…”

mentioning

confidence: 99%

Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time

Lockwood

Perez

Musick

et al. 2016

Infect. Control Hosp. Epidemiol.

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objective. To assess the impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) mass spectrometry for rapid pathogen identification directly from early-positive blood cultures coupled with an antimicrobial stewardship program (ASP) in two community hospitals. Process measures and outcomes prior and after implementation of MALDI-TOF/ASP were evaluated.design. Multicenter retrospective study.setting. Two community hospitals in a system setting, Houston Methodist (HM) Sugar Land Hospital (235 beds) or HM Willowbrook Hospital (241 beds).patients. Patients ≥18 years of age with culture-proven Gram-negative bacteremia.intervention. Blood cultures from both hospitals were sent to and processed at our central microbiology laboratory. Clinical pharmacists at respective hospitals were notified of pathogen ID and susceptibility results.results. We evaluated 572 patients for possible inclusion. After pre-defined exclusion criteria, 151 patients were included in the pre-intervention group and 242 were included in the intervention group. After MALDI-TOF/ASP implementation, the mean identification time after culture positivity was significantly reduced from 32 hours (±16 hours) to 6.5 hours (±5.4 hours) (P < .001); mean time to susceptibility results was significantly reduced from 48 (±22) hours to 23 (±14) hours (P < .001); and time to therapy adjustment was significantly reduced from 75 (±59) hours to 30 (±30) hours (P < .001). Mean hospital costs per patient were $3,411 less in the intervention group compared with the pre-intervention group ($18,645 vs $15,234; P = .04).conclusion. This study is the first to analyze the impact of MALDI-TOF coupled with an ASP in a community hospital setting. Time to results significantly differed with the use of MALDI-TOF, and time to appropriate therapy was significantly improved with the addition of ASP.

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“…50,51 Regarding PNA FISH, Forrest and colleagues utilized a C. albicans-specific probe for yeast-positive blood cultures in 2004; all PNA FISH results were reported to the ASP since approval was required to release antifungal therapy to the primary teams. 52 The median time required to identify C. albicans compared to conventional culture (9.5 hours vs 44 hours, P < 0.001) was significantly reduced.…”

Section: Improving Diagnosis Of Invasive Candidiasismentioning

confidence: 99%

Antifungal stewardship considerations for adults and pediatrics

2016

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Antifungal stewardship refers to coordinated interventions to monitor and direct the appropriate use of antifungal agents in order to achieve the best clinical outcomes and minimize selective pressure and adverse events. Antifungal utilization has steadily risen over time in concert with the increase in number of immunocompromised adults and children at risk for invasive fungal infections (IFI). Challenges in diagnosing IFI often lead to delays in treatment and poorer outcomes. There are also emerging data linking prior antifungal exposure and suboptimal dosing to the emergence of antifungal resistance, particularly for Candida. Antimicrobial stewardship programs can take a multi-pronged bundle approach to ensure suitable prescribing of antifungals via postprescription review and feedback and/or prior authorization. Institutional guidelines can also be developed to guide diagnostic testing in at-risk populations; appropriate choice, dose, and duration of antifungal agent; therapeutic drug monitoring; and opportunities for de-escalation and intravenous-to-oral conversion.

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Impact of Rapid Organism Identification via Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Combined With Antimicrobial Stewardship Team Intervention in Adult Patients With Bacteremia and Candidemia

Abstract: MALDI-TOF with AST intervention decreased time to organism identification and time to effective and optimal antibiotic therapy.

Cited by 470 publications

References 19 publications

Clinical and laboratory considerations for the rapid detection of carbapenem-resistant Enterobacteriaceae

Clinical and laboratory considerations for the rapid detection of carbapenem-resistant Enterobacteriaceae

Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time

Antifungal stewardship considerations for adults and pediatrics

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