Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-05T05:29:37.325Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of rapid diagnostics with antimicrobial stewardship support for children with positive blood cultures: A quasi-experimental study with time trend analysis

Published online by Cambridge University Press:  23 June 2020

Alison C. Tribble Open the ORCID record for Alison C. Tribble [Opens in a new window] ,
Jeffrey S. Gerber ,
Warren B. Bilker  and
Ebbing Lautenbach
Alison C. Tribble*
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
Jeffrey S. Gerber
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Ebbing Lautenbach
Affiliation:
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
*
Author for correspondence: Alison C. Tribble, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Evaluate the clinical impact of the implementation of VERIGENE gram-positive blood culture testing (BC-GP) coupled with antimicrobial stewardship result notification for children with positive blood cultures.

Design:

Quasi-experimental study.

Setting:

Quaternary children’s hospital.

Patients:

Hospitalized children aged 0–21 years with positive blood culture events 1 year before and 1 year after implementation of BC-GP testing.

Methods:

The primary outcome was time to optimal antibiotic therapy for positive blood cultures, defined as receiving definitive therapy without unnecessary antibiotics (pathogens) or no antibiotics (contaminants). Secondary outcomes were time to effective therapy, time to definitive therapy, and time to stopping vancomycin, length of stay, and 30-day mortality. Time-to-therapy outcomes before and after the intervention were compared using Cox regression models and interrupted time series analyses, adjusting for patient characteristics and trends over time. Gram-negative events were included as a nonequivalent dependent variable.

Results:

We included 264 preintervention events (191 gram-positive, 73 gram-negative) and 257 postintervention events (168 gram-positive, 89 gram-negative). The median age was 2.9 years (interquartile range, 0.3–10.1), and 418 pediatric patients (80.2%) had ≥1 complex chronic condition. For gram-positive isolates, implementation of BC-GP testing was associated with an immediate reduction in time to optimal therapy and time to stopping vancomycin for both analyses. BC-GP testing was associated with decreased time to definitive therapy in interrupted time series analysis but not Cox modeling. No such changes were observed for gram-negative isolates. No changes in time to effective therapy, length of stay, or mortality were associated with BC-GP.

Conclusions:

The implementation of BC-GP testing coupled with antimicrobial stewardship result notification was associated with decreased time to optimal therapy and time to stopping vancomycin for hospitalized children with gram-positive blood culture isolates.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 8 , August 2020 , pp. 883 - 890
Check for updates
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Raymond, J, Aujard, Y, European Study Group. Nosocomial infections in pediatric patients: a European, multicenter prospective study. Infect Control Hosp Epidemiol 2000;21:260–263.CrossRefGoogle Scholar
Gray, James W.A 7-year study of bloodstream infections in an English children’s hospital. Eur J Pediatr 2004;163:530–535.CrossRefGoogle Scholar
Larru, B, Gong, W, Vendetti, N, et al.Bloodstream infections in hospitalized children: epidemiology and antimicrobial susceptibilities. Pediatric Infect Dis J 2016;35:507–510.CrossRefGoogle ScholarPubMed
Spaulding, AB, Watson, D, Dreyfus, J, et al.Epidemiology of bloodstream infections in hospitalized children in the United States, 2009–2016. Clin Infect Dis 2019;69:995–1002.CrossRefGoogle ScholarPubMed
Goudie, A, Dynan, L, Brady, PW, Rettiganti, M.Attributable cost and length of stay for central line-associated bloodstream infections. Pediatrics 2014;133:e1525–e1532.CrossRefGoogle ScholarPubMed
Burke, RE, Halpern, MS, Baron, EJ, Gutierrez, K.Pediatric and neonatal Staphylococcus aureus bacteremia: epidemiology, risk factors, and outcome. Infect Control Hosp Epidemiol 2009;30:636–644.CrossRefGoogle ScholarPubMed
Folgori, L, Livadiotti, S, Carletti, M, et al.Epidemiology and clinical outcomes of multidrug-resistant gram-negative bloodstream infections in a European tertiary pediatric hospital during a 12-month period. Pediatric Infect Dis J 2014;33:929–932.CrossRefGoogle Scholar
Gray, J, Gossain, S, Morris, K.Three-year survey of bacteremia and fungemia in a pediatric intensive care unit. Pediatric Infect Dis J 2001;20:416–421.CrossRefGoogle Scholar
Nguyen, HB, Rivers, EP, Abrahamian, FM, et al.Severe sepsis and septic shock: review of the literature and emergency department management guidelines. Ann Emergency Med 2006;48(1):54.e1.CrossRefGoogle ScholarPubMed
Avdic, E, Carroll, KC.The role of the microbiology laboratory in antimicrobial stewardship programs. Infect Dis Clin N Am 2014;28:215–235.CrossRefGoogle ScholarPubMed
Timbrook, TT, Morton, JB, McConeghy, KW, Caffrey, AR, Mylonakis, E, LaPlante KL. The effect of molecular rapid diagnostic testing on clinical outcomes in bloodstream infections: a systematic review and meta-analysis. Clin Infect Dis 2017;64:15–23.CrossRefGoogle ScholarPubMed
Felsenstein, S, Bender, JM, Sposto, R, Gentry, M, Takemoto, C, Bard, JD.Impact of a rapid blood culture assay for gram-positive identification and detection of resistance markers in a pediatric hospital. Arch Pathol Lab Med 2016;140:267–275.CrossRefGoogle Scholar
Reuter, CH, Palac, HL, Kociolek, LK, et al.Ideal and actual impact of rapid diagnostic testing and antibiotic stewardship on antibiotic prescribing and clinical outcomes in children with positive blood cultures. Pediatric Infect Dis J 2019;38:131–137.CrossRefGoogle ScholarPubMed
Messacar, K, Hurst, AL, Child, J, et al.Clinical impact and provider acceptability of real-time antimicrobial stewardship decision support for rapid diagnostics in children with positive blood culture results. J Pediatric Infect Dis Soc 2017;6:267–274.Google ScholarPubMed
Malcolmson, C, Ng, K, Hughes, S, et al.Impact of matrix-assisted laser desorption and ionization time-of-flight and antimicrobial stewardship intervention on treatment of bloodstream infections in hospitalized children. J Pediatric Infect Dis Soc 2017;6:178–186.Google ScholarPubMed
Bhavsar, SM, Dingle, TC, Hamula, CL.The impact of blood culture identification by MALDI-TOF MS on the antimicrobial management of pediatric patients. Diagn Microbiol Infect Dis 2018;92:220–225.CrossRefGoogle ScholarPubMed
Veesenmeyer, AF, Olson, JA, Hersh, AL, et al.A retrospective study of the impact of rapid diagnostic testing on time to pathogen identification and antibiotic use for children with positive blood cultures. Infect Dis Ther 2016;5:555–570.CrossRefGoogle ScholarPubMed
Harris, AD, Bradham, DD, Baumgarten, M, Zuckerman, IH, Fink, JC, Perencevich, EN.The use and interpretation of quasi-experimental studies in infectious diseases. Clin Infect Dis 2004;38:1586–1591.Google ScholarPubMed
Ramsay, C, Brown, E, Hartman, G, Davey, P.Room for improvement: a systematic review of the quality of evaluations of interventions to improve hospital antibiotic prescribing. J Antimicrob Chemother 2003;52:764–771.CrossRefGoogle ScholarPubMed
Schweizer, ML, Braun, BI, Milstone, AM.Research methods in healthcare epidemiology and antimicrobial stewardship—quasi-experimental designs. Infect Control Hosp Epidemiol 2016;37:1135–1140.CrossRefGoogle ScholarPubMed
Feudtner, C, Christakis, DA, Connell, FA.Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington state, 1980–1997. Pediatrics 2000;106 suppl1:205–209.Google ScholarPubMed
AHRQ QI ICD-9-CM specification version 6.0 patient safety indicators appendices. Appendix I: Immunocompromised state diagnosis and procedure codes. Agency for Healthcare Research and Quality website. https://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V60-ICD09/TechSpecs/PSI_Appendix_I.pdf. Accessed August 21, 2019.Google Scholar
Schweizer, ML, Furuno, JP, Harris, AD, et al.Comparative effectiveness of nafcillin or cefazolin versus vancomycin in methicillin-susceptible Staphylococcus aureus bacteremia. BMC Infect Dis 2011;11:279.CrossRefGoogle ScholarPubMed
McDanel, JS, Perencevich, EN, Diekema, DJ, et al.Comparative effectiveness of beta-lactams versus vancomycin for treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections among 122 hospitals. Clin Infect Dis 2015;61:361–367.CrossRefGoogle ScholarPubMed
Leibovici, L, Shraga, I, Drucker, M, Konigsberger, H, Samra, Z, Pitlik, SD.The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998;244:379–386.CrossRefGoogle ScholarPubMed
Supplementary material: File

Tribble et al. supplementary material

Tables S1-S4

Download Tribble et al. supplementary material(File)
File 43.9 KB