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Assessment of Time to Clinical Response in Patients with Sepsis Treated Before and After Implementation of a Matrix-Assisted Laser Desorption Ionization Time-of-Flight Blood Culture Identification Algorithm

Published online by Cambridge University Press:  09 June 2016

Joseph J. Carreno ,
Ben M. Lomaestro ,
Apryl L. Jacobs ,
Rachel E. Meyer ,
Ann Evans  and
Clemente I. Montero
Joseph J. Carreno*
Affiliation:
Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York
Ben M. Lomaestro
Affiliation:
Department of Pharmacy, Albany Medical Center Hospital Albany, New York
Apryl L. Jacobs
Affiliation:
Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York
Rachel E. Meyer
Affiliation:
Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York
Ann Evans
Affiliation:
Department of Microbiology, Albany Medical Center Hospital, Albany, New York
Clemente I. Montero
Affiliation:
Department of Microbiology, Albany Medical Center Hospital, Albany, New York
*
Address correspondence to Joseph J. Carreno, PharmD, Albany College of Pharmacy and Health Sciences, School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice, Albany, NY, 12208 ([email protected]).
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Abstract

OBJECTIVE

To evaluate time to clinical response before and after implementation of rapid blood culture identification technologies.

DESIGN

Before-and-after trial.

SETTING

Large, tertiary, urban, academic health-sciences center.

PATIENTS

Patients >18 years old with sepsis and concurrent bacteremia or fungemia were included in the study; patients who were pregnant, had polymicrobial septicemia, or were transferred from an outside hospital were excluded.

INTERVENTION

Prior to the intervention, polymerase chain reaction was used to identify Staphylococcus species from positive blood cultures, and traditional laboratory techniques were used to identify non-staphylococcal species. After the intervention, matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) assay and FilmArray were also used to identify additional species. During both periods, the antimicrobial stewardship team provided prospective audit and feedback for all patients on antibiotics.

RESULTS

A total of 219 patients were enrolled in the study: 115 patients prior to the intervention and 104 after the intervention. The median time to clinical response was statistically significantly shorter in the postintervention group than in the preintervention group (2 days vs 4 days, respectively; P=.002). By Cox regression, the implementation of MALDI-TOF and FilmArray was associated with shorter time to clinical response (hazard ratio [HR], 1.360; 95% confidence interval [CI], 1.018–1.816). After controlling for potential confounders, the study group was not independently associated with clinical response (adjusted HR, 1.279; 95% CI, 0.955–1.713). Mortality was numerically, but not statistically significantly, lower in the postintervention group than in the preintervention group (7.6% vs 11.4%; P=.342).

CONCLUSIONS

In the setting of an existing antimicrobial stewardship program, implementation of MALDI-TOF and FilmArray was associated with improved time to clinical response. Further research is needed to fully describe the effect of antimicrobial stewardship programs on time to clinical response.

Infect Control Hosp Epidemiol 2016;37:916–923

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 8 , August 2016 , pp. 916 - 923
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. These data were presented in part in Abstract K-659 at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington, District of Columbia, on September 7, 2014.

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