Combination of a Rapid Diagnostic Assay and Antimicrobial Stewardship Intervention on Gram-negative Bacteremia

Abstract

Background Traditional blood cultures for gram-negative bacteremia can take up to 72 hours or more to return results, prolonging the duration of empiric broad-spectrum intravenous antibiotics. The Accelerate Pheno® system provides rapid identification and susceptibilities for blood cultures in gram-negative bacteremia. Current data on its clinical utility is mixed overall and requires further research. Methods A multi-center, retrospective quasi-experimental study was conducted comparing the Accelerate Pheno® rapid diagnostic system with antimicrobial stewardship intervention and traditional blood cultures alone. Results A total of 264 patients with blood cultures with gram-negative bacteria growth were included in the final analysis (102 pre-intervention, 162 post-intervention). The antimicrobial stewardship team made 364 recommendations in 152/162 (93.8%) patients in the post-group. Duration of intravenous therapy was shorter (p<0.001) for the post-intervention group (median 4.0 days) compared to the pre-intervention group (median 7.5 days). Hospital length of stay was also shorter (p<0.001) for the post-intervention group (median 5.1 days) compared to the pre-intervention group (median 7.0 days). Readmission rates within 30 days were reduced (p=0.042) post-intervention (13.0%) compared to pre-intervention (22.6%). In the post-intervention group, a larger proportion of patients were transitioned to oral therapy at any point (126/162, 77.8%) compared to pre-intervention (62/102, 60.8%) (p<0.001). Conclusions These results suggest that the Accelerate Pheno® with active review and intervention by a multidisciplinary antimicrobial stewardship team is a useful tool in improving both patient-centric and antimicrobial stewardship outcomes.