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Automated Alerts Coupled with Antimicrobial Stewardship Intervention Lead to Decreases in Length of Stay in Patients with Gram-Negative Bacteremia

Published online by Cambridge University Press:  10 May 2016

Jason M. Pogue ,
Ryan P. Mynatt ,
Dror Marchaim ,
Jing J. Zhao ,
Viktorija O. Barr ,
Judy Moshos ,
Bharath Sunkara ,
Teena Chopra ,
Sowmya Chidurala  and
Keith S. Kaye
Jason M. Pogue*
Affiliation:
Department of Pharmacy, Sinai-Grace Hospital, Detroit Medical Center, Detroit, Michigan Wayne State University School of Medicine, Detroit, Michigan
Ryan P. Mynatt
Affiliation:
Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan
Dror Marchaim
Affiliation:
Wayne State University School of Medicine, Detroit, Michigan
Jing J. Zhao
Affiliation:
Department of Pharmacy, Harper University Hospital, Detroit Medical Center, Detroit, Michigan
Viktorija O. Barr
Affiliation:
Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan
Judy Moshos
Affiliation:
Sinai-Grace Hospital, Detroit Medical Center, Detroit, Michigan
Bharath Sunkara
Affiliation:
Wayne State University School of Medicine, Detroit, Michigan
Teena Chopra
Affiliation:
Wayne State University School of Medicine, Detroit, Michigan Department of Internal Medicine, Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan
Sowmya Chidurala
Affiliation:
Wayne State University School of Medicine, Detroit, Michigan
Keith S. Kaye
Affiliation:
Wayne State University School of Medicine, Detroit, Michigan Department of Internal Medicine, Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan
*
Sinai-Grace Hospital, Detroit Medical Center, 6071 West Outer Drive, Detroit, MI 48235 (jpogue@dmc.org)
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Abstract

Objective.

To assess the impact of active alerting of positive blood culture data coupled with stewardship intervention on time to appropriate therapy, length of stay, and mortality in patients with gram-negative bacteremia.

Design.

Quasi-experimental retrospective cohort study in patients with gram-negative bacteremia at the Detroit Medical Center from 2009 to 2011.

Setting.

Three hospitals (1 community, 2 academic) with active antimicrobial stewardship programs within the Detroit Medical Center.

Patients.

All patients with monomicrobial gram-negative bacteremia during the study period.

Intervention.

Active alerting of positive blood culture data coupled with stewardship intervention (2010-2011) compared with patients who received no formalized stewardship intervention (2009).

Results.

Active alerting and intervention led to a decreased time to appropriate therapy (8 [interquartile range (IQR), 2-24] vs 14 [IQR, 2-35] hours; P = .014) in patients with gram-negative bacteremia. After controlling for differences between groups, being in the intervention arm was associated with an independent reduction in length of stay (odds ratio [OR], 0.73 [95% confidence interval (CI), 0.62-0.86]), correlating to a median attributable decrease in length of stay of 2.2 days. Additionally, multivariate modeling of patients who were not on appropriate antimicrobial therapy at the time of initial culture positivity showed that patients in the intervention group had a significant reduction in both length of stay (OR, 0.76 [95% CI, 0.66-0.86]) and infection-related mortality (OR, 0.24 [95% CI, 0.08-0.76]).

Conclusions.

Active alerting coupled with stewardship intervention in patients with gram-negative bacteremia positively impacted time to appropriate therapy, length of stay, and mortality and should be a target of antimicrobial stewardship programs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 2 , February 2014 , pp. 132 - 138
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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References

1. Dellit, TH, Owens, RC, Mcgowan, JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44: 159–177.CrossRefGoogle Scholar
2. Leibovici, L, Shraga, I, Drucker, M, Konigsberger, H, Samra, Z, Pitlik, SD. The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998; 244(5):379–386.CrossRefGoogle ScholarPubMed
3. Micek, ST, Welch, EC, Khan, J, et al. Resistance to empiric antimicrobial treatment predicts outcome in severe sepsis associated with gram-negative bacteremia. J Hosp Med 2011;6(7):405–410.CrossRefGoogle ScholarPubMed
4. Kumar, A, Roberts, D, Wood, KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:1589–1596.CrossRefGoogle ScholarPubMed
5. Holtzman, C, Whitney, D, Barlam, T, Miller, NS. Assessment of impact of peptide nucleic acid fluorescence in situ hybridization for identification of coagulase-negative staphylococci in the absence of antimicrobial stewardship intervention. J Clin Microbiol 2011;49(4):1581–1582.CrossRefGoogle ScholarPubMed
6. Perez, KK, Olsen, RJ, Musick, WL, et al. Integrating rapid pathogen identification and antimicrobial stewardship significantly decreases hospital costs. Arch Pathol Lab Med 2013;137(9):1247–1254.CrossRefGoogle ScholarPubMed
7. Bauer, KA, West, JE, Balada-Llast, JM, et al. An antimicrobial stewardship program's impact with rapid polymerase chain reaction methicillin-resistant Staphylococcus aureus/S. aureus blood culture test in patients with S. aureus bacteremia. Clin Infect Dis 2010;51(9):1074–1080.CrossRefGoogle ScholarPubMed
8. Wong, JR, Bauer, KA, Mangino, JE, Goff, DA. Antimicrobial stewardship pharmacist interventions for coagulase-negative staphylococci positive blood cultures using rapid polymerase chain reaction. Ann Pharmacother 2012;46(11):1484–1490.CrossRefGoogle ScholarPubMed
9. Nowak, MA, Nelson, RE, Breidenbach, JL, et al. Clinical and economic outcomes of a prospective antimicrobial stewardship program. Am J Health Syst Pharm 2012;69(17):1500–1508.CrossRefGoogle ScholarPubMed
10. Rullar, R, Davis, SL, Kaye, KS, et al. Implementation of an antimicrobial stewardship pathway with daptomycin for optimal treatment of methicillin-resistant Staphylococcus aureus bacteremia. Pharmacotherapy 2013;33(1):3–10.Google Scholar
11. Malani, AN, Richards, PG, Rapila, S, et al. Clinical and economic outcomes from a community hospital's antimicrobial stewardship program. Am J Infect Control 2013;41(2):145–148.CrossRefGoogle ScholarPubMed