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Rapid diagnostics, antimicrobial stewardship intervention improved time to effective therapy
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The use of rapid diagnostic testing along with intervention by antimicrobial stewardship teams decreased the time to identify organisms, as well as time to receipt of effective antimicrobial therapy, according to a report in Clinical Infectious Diseases.
The two-step intervention included the identification of organisms using matrix-assisted laser-desorption/ionization time-of-flight (MALDI-TOF), followed by an intervention by a member of the antimicrobial stewardship team, who provided prescribers with real-time evidence-based antibiotic recommendations immediately following culture results.
“At most hospitals, prescribers are notified in real time of positive Gram’s stain results from the microbiology lab, but not organism identification or susceptibilities results,” Jerod Nagel, PharmD, clinical specialist in infectious diseases at the University of Michigan Hospitals and Health System, told Infectious Disease News. “Data on resistance could be available for up to 24 hours before antibiotic modifications are made. This laboratory-stewardship team interface improved time to optimal antibiotic therapy, leading to improved mortality, decreased length of stay and dramatic reduction in costs.”
Jerod Nagel
Nagel and colleagues conducted the study that included 501 patients. A group of 256 patients who had a bloodstream infection identified with MALDI-TOF and the antimicrobial stewardship team intervention from Sept. 1 to Nov. 30, 2012, were compared with a group of 245 historical controls.
They found that the use of MALDI-TOF decreased time to organism identification by more than 30 hours: 84 vs. 55.9 hours (P<.001). Integrating real-time review and intervention by antimicrobial stewardship teams also improved the time to effective therapy by almost 10 hours (30.1 vs. 20.4 hours; P=.021) and time to effective therapy by more than 40 hours (90.3 vs. 47.3 hours; P<.001).
The use of MALDI-TOF and antimicrobial stewardship team intervention also led to a reduction in 30-day all-cause mortality (20.3% vs. 12.7%; P=.021) and improved overall survival, as well as a significant reduction in ICU length of stay.
“There are numerous studies with different technologies and different intervention methods, which have almost unanimously demonstrated improved outcomes and reduced costs with rapid organism identification and real-time intervention,” Nagel said. “Given the growing number of studies demonstrating significant improvements in outcomes and reduction in costs, hospitals should consider implementing an antimicrobial stewardship team to receive real-time notifications following positive blood cultures.”
Disclosure: Nagel reports no relevant financial disclosures.
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