Skip to main content Accesibility Help
×
×
Home

Experience With Rapid Microarray-Based Diagnostic Technology and Antimicrobial Stewardship for Patients With Gram-Positive Bacteremia

  • Elizabeth A. Neuner (a1), Andrea M. Pallotta (a1), Simon W. Lam (a1), David Stowe (a1), Steven M. Gordon (a2), Gary W. Procop (a3) and Sandra S. Richter (a3)...
  • Please note a correction has been issued for this article.
Abstract
OBJECTIVE

To describe the impact of rapid diagnostic microarray technology and antimicrobial stewardship for patients with Gram-positive blood cultures.

DESIGN

Retrospective pre-intervention/post-intervention study.

SETTING

A 1,200-bed academic medical center.

PATIENTS

Inpatients with blood cultures positive for Staphylococcus aureus, Enterococcus faecalis, E. faecium, Streptococcus pneumoniae, S. pyogenes, S. agalactiae, S. anginosus, Streptococcus spp., and Listeria monocytogenes during the 6 months before and after implementation of Verigene Gram-positive blood culture microarray (BC-GP) with an antimicrobial stewardship intervention.

METHODS

Before the intervention, no rapid diagnostic technology was used or antimicrobial stewardship intervention was undertaken, except for the use of peptide nucleic acid fluorescent in situ hybridization and MRSA agar to identify staphylococcal isolates. After the intervention, all Gram-positive blood cultures underwent BC-GP microarray and the antimicrobial stewardship intervention consisting of real-time notification and pharmacist review.

RESULTS

In total, 513 patients with bacteremia were included in this study: 280 patients with S. aureus, 150 patients with enterococci, 82 patients with stretococci, and 1 patient with L. monocytogenes. The number of antimicrobial switches was similar in the pre–BC-GP (52%; 155 of 300) and post–BC-GP (50%; 107 of 213) periods. The time to antimicrobial switch was significantly shorter in the post–BC-GP group than in the pre–BC-GP group: 48±41 hours versus 75±46 hours, respectively (P<.001). The most common antimicrobial switch was de-escalation and time to de-escalation, was significantly shorter in the post-BC-GP group than in the pre–BC-GP group: 53±41 hours versus 82±48 hours, respectively (P<.001). There was no difference in mortality or hospital length of stay as a result of the intervention.

CONCLUSIONS

The combination of a rapid microarray diagnostic test with an antimicrobial stewardship intervention improved time to antimicrobial switch, especially time to de-escalation to optimal therapy, in patients with Gram-positive blood cultures.

Infect Control Hosp Epidemiol 2016;1–6

Copyright
Corresponding author
Address correspondence to Elizabeth A. Neuner, PharmD, Department of Pharmacy, Cleveland Clinic, Cleveland, OH 44195 (neunere@ccf.org).
Footnotes
Hide All

PREVIOUS PRESENTATION. Presented in part as poster 1492 at IDWeek, San Diego, California, October 10, 2015.

Footnotes
References
Hide All
1. Fridkin, S, Baggs, J, Fagan, R, et al. Vital signs: improving antibiotic use among hospitalized patients. MMWR 2014;63:194200.
2. Core elements of hospital antimicrobial stewardship programs. US Department of Health and Human Services. Centers for Disease Control and Prevention website. http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html. Published 2014. Accessed, July 5, 2016.
3. Forrest, GN, Roghmann, MC, Toombs, LS, et al. Peptide nucleic acid fluorescent in situ hybridization for hospital-acquired enterococcal bacteremia: delivering earlier effective antimicrobial therapy. Antimicrob Agents Chemother 2008;52:35583563.
4. Bauer, KA, West, JE, Balada-Llasat, JM, Pancholi, P, Stevenson, KB, Goff, DA. 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;51:10741080.
5. Banerjee, R, Teng, CB, Cunningham, SA, et al. Randomized trial of rapid multiplex polymerase chain reaction-based blood culture identification and susceptibility testing. Clin Infect Dis 2015;61:10711080.
6. Huang, AM, Newton, D, Kunapuli, A, et al. 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. Clin Infect Dis 2013;57:12371245.
7. Roshdy, DG, Tran, A, LeCroy, N, et al. Impact of a rapid microarray-based assay for identification of positive blood cultures for treatment optimization for patients with streptococcal and enterococcal bacteremia. J Clin Microbiol 2015;53:14111414.
8. Sango, A, McCarter, YS, Johnson, D, Ferreira, J, Guzman, N, Jankowski, CA. Stewardship approach for optimizing antimicrobial therapy through use of a rapid microarray assay on blood cultures positive for Enterococcus species. J Clin Microbiol 2013;51:40084011.
9. Box, MJ, Sullivan, EL, Ortwine, KN, et al. Outcomes of rapid identification for Gram-positive bacteremia in combination with antibiotic stewardship at a community-based hospital system. Pharmacotherapy 2015;35:269276.
10. Caliendo, AM, Gilbert, DN, Ginocchio, CC, et al. Better tests, better care: improved diagnostics for infectious diseases. Clin Infect Dis 2013;57:S139S170.
11. Buehler, SS, Madison, B, Snyder, SR, et al. Effectiveness of practices to increase timeliness of providing targeted therapy for inpatients with bloodstream infections: a laboratory medicine best practices systematic review and meta-analysis. Clin Microbiol Rev 2016;29:59103.
12. Forrest, GN, Mehta, S, Weekes, E, Lincalis, DP, Johnson, JK, Venezia, RA. Impact of rapid in situ hybridization testing on coagulase-negative staphylococci positive blood cultures. J Antimicrob Chemother 2006;58:154158.
13. Nagel, JL, Huang, AM, Kunapuli, A, et al. Impact of antimicrobial stewardship intervention on coagulase-negative Staphylococcus blood cultures in conjunction with rapid diagnostic testing. J Clin Microbiol 2014;52:28492854.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed