Impact of Rapid Blood Culture Identification on Antibiotic De-escalation at a Veterans Affairs Medical Center.

Abstract

Background: Timely de-escalation of antibiotics improves patient outcomes and reduces costs. The BioFire FilmArray Blood Culture Identification (BCID2) panel, a rapid diagnostic technology, enables enhanced antimicrobial stewardship. This study evaluated whether BCID2 use at Veteran Health Indiana (VHI) saved time and money to prescribe optimal antibiotics from blood culture draw pre- and postimplementation.

Methods: This pre-post quasi-experimental study evaluated patients with bacteremia at VHI between March 1, 2022, and October 1, 2023. Patient data were generated using electronic health records and microbiology laboratory data. A random sampling of eligible patients was included if they had a positive bacterial blood culture for which they received ≥ 1 antibiotic while hospitalized.

Results: Median difference in time to organism identification was 37.8 hours in the preintervention group vs 16.9 hours in the postintervention group (P < .001). Other differences in time were not statistically significant. Median difference in time to optimal antibiotics was 58.5 hours in the preintervention group vs 43.4 hours in the postintervention group (P = .11). Median difference in time on antibiotics was 45.2 hours in the preintervention group vs 46.6 hours in the postintervention group (P = .99). Median difference in time on appropriate antibiotics was 2.3 hours in the preintervention group vs 1.9 hours in the postintervention group (P = .79).

Conclusions: BCID2 use resulted in a decrease in median time to optimal antibiotics that was not statistically significant. Additional barriers to optimal antibiotic prescription should be addressed to maximize rapid blood culture identification technologies and enhance antimicrobial stewardship.