TY - JOUR
T1 - Impact of early antimicrobial stewardship intervention in patients with positive blood cultures
T2 - results from a randomized comparative study
AU - O'Donnell, J. Nicholas
AU - Rhodes, Nathaniel J.
AU - Miglis, Cristina M.
AU - Zembower, Teresa R.
AU - Qi, Chao
AU - Hoff, Brian M.
AU - Barr, Viktorija O.
AU - Gilbert, Elise M.
AU - Bolon, Maureen K.
AU - Malczynski, Michael
AU - Gener, Joshua
AU - Tran, Chau
AU - Catovic, Lejla
AU - Postelnick, Michael J.
AU - Sutton, Sarah H.
AU - Scheetz, Marc H.
N1 - Publisher Copyright:
© 2021 Elsevier Ltd and International Society of Antimicrobial Chemotherapy
PY - 2022/2
Y1 - 2022/2
N2 - Background: Antimicrobial stewardship intervention (ASI) appears to be necessary to realize the full benefits of rapid diagnostic technologies in clinical practice. This study aimed to compare clinical outcomes between early ASI paired with matrix-associated laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) compared with MALDI-TOF with standard of care (SOC) reporting in patients with positive blood cultures. Methods: Adult patients with positive blood cultures and organism speciation via MALDI-TOF admitted between February 2015 and September 2015 were randomized to ASI or SOC in a 1:1 fashion. Patients admitted for at least 48 h following positive culture were included in analyses. ASI was defined as a clinical assessment by a stewardship team member with non-binding treatment recommendations offered to the primary team. The primary outcome was time to definitive therapy. Secondary outcomes included post-culture length of stay (LOS), time to first change in antibiotics, and in-hospital mortality. Results: In total, 149 patients were included in the analyses (76 in the ASI group and 73 in the SOC group). ASI and SOC arms did not differ according to age, sex, comorbidities or severity of illness. Gram-positive organisms were common in both SOC and ASI arms (74.0 vs. 61.8%, P=0.11). Time to definitive therapy was reduced, on average, by 30.3 h in the ASI group (71.6 vs. 41.3 h, P=0.01). Hospital LOS following the first positive blood culture was significantly shorter in the ASI group (8.7 vs. 11.2 days, P=0.049). Conclusions: ASI combined with MALDI-TOF reduced the time to definitive therapy and time to first change in antibiotics, and was associated with a shorter post-culture LOS.
AB - Background: Antimicrobial stewardship intervention (ASI) appears to be necessary to realize the full benefits of rapid diagnostic technologies in clinical practice. This study aimed to compare clinical outcomes between early ASI paired with matrix-associated laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) compared with MALDI-TOF with standard of care (SOC) reporting in patients with positive blood cultures. Methods: Adult patients with positive blood cultures and organism speciation via MALDI-TOF admitted between February 2015 and September 2015 were randomized to ASI or SOC in a 1:1 fashion. Patients admitted for at least 48 h following positive culture were included in analyses. ASI was defined as a clinical assessment by a stewardship team member with non-binding treatment recommendations offered to the primary team. The primary outcome was time to definitive therapy. Secondary outcomes included post-culture length of stay (LOS), time to first change in antibiotics, and in-hospital mortality. Results: In total, 149 patients were included in the analyses (76 in the ASI group and 73 in the SOC group). ASI and SOC arms did not differ according to age, sex, comorbidities or severity of illness. Gram-positive organisms were common in both SOC and ASI arms (74.0 vs. 61.8%, P=0.11). Time to definitive therapy was reduced, on average, by 30.3 h in the ASI group (71.6 vs. 41.3 h, P=0.01). Hospital LOS following the first positive blood culture was significantly shorter in the ASI group (8.7 vs. 11.2 days, P=0.049). Conclusions: ASI combined with MALDI-TOF reduced the time to definitive therapy and time to first change in antibiotics, and was associated with a shorter post-culture LOS.
KW - Bloodstream infection
KW - Randomized controlled trial
KW - Rapid diagnostics
KW - Stewardship
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U2 - 10.1016/j.ijantimicag.2021.106490
DO - 10.1016/j.ijantimicag.2021.106490
M3 - Article
C2 - 34871745
AN - SCOPUS:85123302405
SN - 0924-8579
VL - 59
JO - International Journal of Antimicrobial Agents
JF - International Journal of Antimicrobial Agents
IS - 2
M1 - 106490
ER -