Effect of a pharmacy-driven rapid bacteremia response program on outcomes in adult patients with extended-spectrum beta-lactamase bacteremia: A retrospective, quasi-experimental study

IF 1.3 Q4 PHARMACOLOGY & PHARMACY

Journal of the American College of Clinical Pharmacy : JACCP Pub Date : 2024-12-14 DOI:10.1002/jac5.2063

Elena A. Swingler Pharm.D., MBA, Madison Clark Pharm.D., Sarah E. Moore Pharm.D., Matthew Song Pharm.D., Jamison Montes de Oca Pharm.D., Stephen Furmanek MPH, M.S., Thomas Chandler MPH, Ashley M. Wilde Pharm.D.

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引用次数: 0

Abstract

Introduction

Rapid diagnostic technology can improve patient outcomes, particularly when combined with Antimicrobial Stewardship Program (ASP) intervention. Bacteremic patients due to drug-resistant organisms are most likely to benefit from rapid diagnostic technologies as they are more likely to be prescribed inadequate empiric therapy. The purpose of this study was to analyze the impact of a pharmacy-driven Rapid Bacteremia Response Program (RBRP) on the process and clinical outcomes of patients with bacteremia due to an extended-spectrum beta-lactamase (ESBL)-producing organism.

Methods

A retrospective, quasi-experimental study was conducted at a large healthcare system. The RBRP was implemented in 2017 to expedite antimicrobial therapy for bacteremia based on Gram stain and Verigene® system (Luminex Corp, Austin, TX, USA) results. Adults hospitalized with ESBL bacteremia were evaluated pre-intervention and post-intervention (utilizing the RBRP). The primary outcome was time to active therapy. Secondary outcomes included in-hospital and 30-day mortality, length of hospital and intensive care unit (ICU) stay, and factors associated with mortality.

Results

A total of 200 patients were included: 100 patients in the pre-intervention and 100 patients in the post-intervention group. The post-intervention group resulted in 6.4 h faster time to active therapy from blood culture collection (median 22.8 h pre-intervention vs. 16.4 h post-intervention, p = 0.001). No statistical difference was identified for the length of hospital or ICU stay and in-hospital or 30-day mortality between groups. Multivariable analysis identified age, male sex, quick Pitt bacteremia score, and hospital-acquired infection to be significantly associated with 30-day mortality.