Table 4.
Comparison of Clinical, Microbiologic, and Cost Outcomes According to Study Group
| Outcome | Control (n = 207) | Rapid Multiplex PCR (n = 198) | Rapid Multiplex PCR + Stewardship (n = 212) | P Value Comparing 3 Groups |
|---|---|---|---|---|
| Clinical outcome | ||||
| Disposition | .12 | |||
| Home | 68 (32.9) | 62 (31.3) | 78 (36.8) | |
| Home with outpatient antimicrobial therapy | 39 (18.8) | 52 (26.3) | 38 (17.9) | |
| Nursing home/skilled nursing facility | 63 (30.4) | 42 (21.2) | 54 (25.5) | |
| Hospice/comfort care | 12 (5.8) | 8 (4) | 7 (3.3) | |
| Death | 11 (5.3) | 11 (5.6) | 8 (3.8) | |
| Length of stay (entire hospitalization), d, median (IQR) | 8 (5–15) | 8 (5–15) | 8 (5–16) | .60 |
| Length of stay (after enrollment), d, median (IQR) | 7 (4–12) | 6 (4–12) | 7 (4–12) | .61 |
| Intensive care unit admission within 14 d after enrollment | 16 (7.7) | 5 (2.5) | 10 (4.7) | .06 |
| Length of stay in intensive care unit (after enrollment), d, median (IQR) | 3 (2–4) | 2 (1–5) | 3 (2–4) | .90 |
| 30-day mortality | 22 (10.6) | 20 (10.1) | 18 (8.5) | .74 |
| 30-day attributable mortality | 7 (3.4) | 7 (3.5) | 2 (0.9) | .42 |
| 30-day readmission for infection with same organism | 6 (2.9) | 6 (3) | 8 (3.8) | .88 |
| Toxicity/adverse drug reactiona | 3 (1.4) | 3 (1.5) | 2 (0.9) | .82 |
| Microbiologic outcomes | ||||
| Blood culture clearance within 3 d after enrollment | 147 (71) | 131 (66.2) | 146 (68.9) | .79 |
| Acquisition of Clostridium difficile or multidrug-resistant organismsb within 30 days after enrollment | 15 (7.2) | 16 (8.1) | 21 (9.9) | .62 |
| Cost per hospitalized patient, mean (median) | ||||
| Overall hospitalization costs | $65 450 ($27 192) | $66 887 ($23 935) | $68 729 ($29 064) | .78 |
| Test costs | $5377 ($2082) | $5680 ($2585)c | $5743 ($2774)c | <.001 |
| Antimicrobial costs | $2194 ($990) | $1932 ($866) | $1741 ($890) | .65 |
Data are presented as No. (%) unless otherwise specified.
Abbreviations: IQR, interquartile range; PCR, polymerase chain reaction.
a Toxicities include seizures, Clostridium difficile infection, hepatitis, myelosuppression, renal insufficiency, prolonged QTc interval, and rash that occurred within 2 weeks following enrollment and were documented in the medical record.
b Multidrug-resistant organisms including vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, extended-spectrum cephalosporin-resistant Enterobacteriaceae, and Pseudomonas aeruginosa and Acinetobacter species resistant to ≥3 antibiotic classes.
c Statistically significant compared to control group.