1806. Implementation of Rapid Diagnostic Testing Without Active Stewardship Team Notification for Gram-Positive Blood Cultures in a Community Teaching Hospital. (26th November 2018)

• Record Type: Journal Article
• Authors: Bukowski, Paige; Dumkow, Lisa; Jacoby, Joshua; Jameson, Andrew
• Is Part Of: Open forum infectious diseases. Volume 5(2018)Supplement 1
• Page Start: S512
• Page End: S512
• Publication Date: 2018-11-26
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy210.1462
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Rapid diagnostic testing (RDT) for Gram-positive blood cultures has previously shown to significantly decrease time to appropriate antibiotic therapy as compared with traditional microbiological methods. Implementation of RDT with antimicrobial stewardship team (AST) notification may significantly improve RDT use and decrease time to optimal therapy; however, in community hospitals with limited resources AST notification may not be feasible. This study aimed to determine the impact of RDT implementation without AST notification on time to appropriate antibiotic therapy for blood cultures growing Gram-positive cocci (GPC) in clusters in a community teaching hospital. Methods: A retrospective quasi-experimental study was conducted evaluating adult inpatients with a blood culture positive for GPC in clusters. The primary outcome of this study was to compare the time to appropriate therapy for Staphylococcal bacteremia in the pre-RDT group (January 1–June 30, 2016) vs. post-RDT group (January 1–June 30, 2017). Secondary endpoints included comparing the number of anti-MRSA doses administered to patients whose cultures grew coagulase-negative staphylococcus (CoNS) determined contaminants and length of stay (LOS) between groups. Results: Two hundred fifty-two patients were included in the study (pre-RDT n = 143, post-RDT n = 109). There were 58 patients with Staphylococcus aureus bacteremia (SAB) and 194 patients with CoNS. Mean time to active therapy for SAB following Gram-stain result was similar between groups (pre-RDT 4.1 hours vs. post-RDT 1.06 hours, P = 0.157). The median time to discontinuation of antibiotics for CoNS contaminants was significantly decreased in the post-RDT group (26.38 vs. 8.27 hours, P = 0.006) and the median number of anti-MRSA doses was also significantly decreased (1 vs. 0 dose, P = 0.003). In the post-RDT group, significantly fewer patients with CoNS cultures had empiric anti-MRSA therapy ordered after Gram-stain (50% vs. 24.4%, P = 0.042). Mean LOS was significantly shorter for patients with CoNS contaminants in the post-RDT group (10.1 vs. 7.5 days, P = 0.036). Conclusion: Implementation of the RDT without AST notification significantly improved time to de-escalation, decreased empiric anti-MRSA antibiotic exposure, and resulted in significantly shorter LOS for patients with CoNS contaminated blood cultures. Disclosures: All authors: No reported disclosures.