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

Abstract

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.

Rapid identification of gram‐negative bacteremia and impact on antipseudomonal antibiotic consumption with antimicrobial stewardship at a community hospital system

“…Two studies have published theoretical applications of using BC‐GN testing in combination with local antibiograms to encourage less use of broad‐spectrum gram‐negative antibiotics . Other studies have shown decreased time to targeted antimicrobial therapy, but these did not include specific data on antibiotic utilization . A study conducted in Japan examining the impact of the gram‐negative and gram‐positive panels for community‐onset bacteremia reported a “common pattern” of de‐escalation among 12 patients with gram‐negative bacteremia from AP to non‐AP antibiotics (10 episodes of E. coli and 2 episodes of K. pneumoniae ) .…”

“…11,12 Other studies have shown decreased time to targeted antimicrobial therapy, but these did not include specific data on antibiotic utilization. 2,6,13 A study conducted in Japan examining the impact of the gram-negative and gram-positive panels for community-onset bacteremia reported a "common pattern" of de-escalation among 12 patients with gram-negative bacteremia from AP to non-AP antibiotics (10 episodes of E. coli and 2 episodes of K. pneumoniae). 14 The value of rapid multiplex polymerase chain reaction (PCR) for bacteremia was assessed in a study conducted at Mayo Clinic.…”

“…Initially, studies focused on gram‐positive infections, but now rapid diagnostic technology has expanded to include gram‐negative infections. Studies examining the outcomes of rapid diagnostics for gram‐negative infections have demonstrated various benefits, including faster identification time, improved time to effective antibiotic therapy, decreased length of stay (LOS), and lower costs …”

Collaborative Antimicrobial Stewardship

“…Studies have shown that rapid identification of an organism by MALDI-TOF can improve time to appropriate antibiotic treatment, but only when associated with ASP collaboration. [16][17][18][19] The laboratory at WFBH implemented MALDI-TOF technology in 2014 and our AS team has been fundamental in educating providers on how to use the early identification result to implement empiric therapy by providing reliable local antibiogram reports. Overall at our institution, the implementation of MALDI-TOF has clearly improved turnaround time for identification of organisms.…”

Top 1% of Inpatients Administered Antimicrobial Agents Comprising 50% of Expenditures: A Descriptive Study and Opportunities for Stewardship Intervention

“…[5][6][7][8][9] A collateral benefit to improved antimicrobial use in the inpatient setting is limiting antimicrobial expenditures. [10][11][12][13][14] For example, Standiford and colleagues 15 demonstrated that implementation of a robust ASP in a large, tertiary academic medical center resulted in a 46% reduction in antimicrobial cost per 1,000 patient-days. However, maintenance of such programs is key as there was a 32% cost increase within 2 years of discontinuation of the program.…”