Oct 10, 2015 - David Stowe, RPh1; Lisa Stempak, MD2; Gary Procop, MD, FIDSA3; Sandra S. Richter,. MD, FIDSA4; 1Pharmacy, Cleveland Clinic, Cleveland, ...
1492. Experience With Rapid Diagnostic Technology and Antimicrobial Stewardship for Patients With Gram-Positive Bloodstream Infections Elizabeth Neuner, PharmD1; Andrea Pallotta, PharmD1; Simon Lam, PharmD1; David Stowe, RPh1; Lisa Stempak, MD2; Gary Procop, MD, FIDSA3; Sandra S. Richter, MD, FIDSA4; 1Pharmacy, Cleveland Clinic, Cleveland, Ohio; 2Cleveland Clinic, Cleveland, Ohio; 3Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio; 4Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio Session: 217. Antimicrobial Stewardship: Role of Diagnostics Saturday, October 10, 2015: 12:30 PM Background. Time to appropriate antimicrobial therapy has been correlated with improved patient outcomes. Rapid diagnostic technology (RDT) can detect pathogens and antimicrobial resistance genes to allow earlier initiation of appropriate therapy and faster de-escalation to more targeted therapy. Current literature focuses on outcomes with single species of organisms; we sought to evaluate clinical outcomes for all target pathogens. Methods. A retrospective pre/post study at Cleveland Clinic, a 1400 bed academic medical center, evaluating adult inpatients with Gram-positive blood cultures before (15 February 2014 to 14 September 2014) and after (15 September 2015 to 14 February 2015) implementation of the RDT (Verigene Gram-Positive Blood Culture Test) and an antimicrobial stewardship (ASP) initiative. The ASP intervention included electronic real-time notification of positive results to infectious diseases (ID) trained pharmacists who then made recommendations on drug therapy. Data collection
included demographic, microbiological, antibiotic related information, and length of stay. Results. 619 patients with blood cultures with Gram-positive organisms other than coagulase-negative staphylococci were screened and 513 included (300 in the pre-RDT group and 213 in the post-RDT group). Majority of patients were on medical services (76% versus 73%) and only 12% versus 16% were in an ICU at time of blood culture. The most common pathogens in both pre-RDT and post-RDT groups were Streptococcus aureus (38% versus 45% MRSA), Enterococcus spp. (25% versus 49% VRE), and Streptococcus spp. Significantly more patients had an antibiotic escalation to appropriate therapy in the post-RDT group (10% versus 16%, p = 0.032) and time to appropriate therapy was improved (50.4 versus 36 hrs, p = 0.17). Time to de-escalation was significantly improved in the post-RDT group (81.6 versus 52.8 hrs). More patients in the post-RDT group received an ID consult (45% versus 86%, p < 0.001). Hospital LOS was not different (21.3 versus 24.5 days, p = 0.27). Conclusion. RDT with antimicrobial stewardship intervention significantly decreased time to de-escalation. The number of ID consults was also significantly increased in the post-RDT group. Disclosures. S. S. Richter, BD diagnostics: Investigator, Research support. OpGen: Investigator, Research support. BioMerieux: Investigator, Research support. Nanosphere: Investigator, Research support. Cerexa: Investigator, Research support. Pocared: Investigator, Research support. Biofire: Investigator, Research support. Achaogen: Investigator, Research support
Poster Abstracts
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OFID 2015:2 (Suppl 1)
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S379
