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7 results

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

  • Elizabeth A. Neuner, Andrea M. Pallotta, Simon W. Lam, David Stowe, Steven M. Gordon, Gary W. Procop, Sandra S. Richter
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 37 / Issue 11 / November 2016
    Published online by Cambridge University Press:
    08 August 2016, pp. 1361-1366
    Print publication:
    November 2016
  • 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

  • AS IF NOTHING SHOULD BE LOST: MICHAEL O'BRIEN, THE AMERICAN SOUTH, AND THE COSMOPOLITAN IDEAL

  • STEVEN M. STOWE
  • Journal:
    Modern Intellectual History / Volume 13 / Issue 1 / April 2016
    Published online by Cambridge University Press:
    15 February 2016, pp. 209-236

  • When groups of historians studying the American South got together in the late 1970s there was a clannish feel, mostly white, mostly male. Mostly southern, too, and while non-southerners were not unwelcome they were noticed. Why are you interested in studying us? was asked politely, with a hint of a hidden punchline, a question for outsiders. So it is a strange turn that an outsider, Michael O'Brien, a soft-spoken, level Englishman, began a career in that decade which would make him one of the leading historians of the South in the second half of the twentieth century and into the twenty-first. Maybe even stranger is that he did this as a historian of southern intellectual life.