TABLE 2.
Microbiology, treatment, and clinical outcomes for all patientsa
| Parameter | Value(s) |
|||
|---|---|---|---|---|
| Control (n = 115) | Stewardship (n = 104) | BCID (n = 145) | P | |
| Microbiology-related outcomes | ||||
| Time to blood culture positivity, h, median (IQR) | 17.3 (14.6–22.0) | 14.2 (12.9–18.2)b | 13.9 (11.9–18.5)b | <0.001 |
| Time to organism identification, h, median (IQR) | 57.4 (42.5–68.5) | 53.9 (40.8–62.5) | 17.2 (13.3–24.8)b,c | <0.001 |
| Time to in vitro susceptibility results, h, median (IQR) | 64.4 (57.4–70.6) | 61.5 (55.6–67.8) | 64.4 (58.6–78.1)c | 0.03 |
| Blood culture pathogens | ||||
| Gram-positive bacteria (n = 168) | 51 (40.2) | 48 (44.4) | 59 (37.1) | 0.58 |
| Enterococcus faecalis (VRE) | 0 | 0 | 1 | |
| Enterococcus faecalis (not VRE) | 8 | 5 | 13 | |
| Enterococcus faecium (VRE) | 0 | 0 | 1 | |
| Enterococcus faecium (not VRE) | 1 | 0 | 0 | |
| Enterococcus avium | 0 | 0 | 2 | |
| Methicillin-resistant Staphylococcus aureus | 14 | 14 | 13 | |
| Methicillin-sensitive Staphylococcus aureus | 18 | 15 | 18 | |
| Staphylococcus spp. (coagulase negative) | 2 | 2 | 4 | |
| Streptococcus agalactiae | 3 | 3 | 2 | |
| Streptococcus pneumoniae | 2 | 1 | 2 | |
| Streptococcus pyogenes | 0 | 1 | 1 | |
| Streptococcus anginosus group | 2 | 0 | 5 | |
| Streptococcus group C | 0 | 1 | 0 | |
| Streptococcus group G | 0 | 1 | 0 | |
| Streptococcus mitis | 4 | 5 | 4 | |
| Gram-negative bacteria (n = 204) | 63 (49.6) | 54 (50) | 87 (54.7) | 0.58 |
| Acinetobacter baumannii | 2 | 2 | 4 | |
| Enterobacter cloacae | 6 | 6 | 7 | |
| Enterobacter aerogenes | 2 | 1 | 4 | |
| Escherichia coli | 20 | 27 | 34 | |
| Klebsiella oxytoca | 1 | 0 | 1 | |
| Klebsiella pneumoniae | 19 | 13 | 21 | |
| Proteus mirabilis | 3 | 2 | 4 | |
| Pseudomonas aeruginosa | 5 | 3 | 6 | |
| Serratia marcescens | 4 | 0 | 4 | |
| Salmonella spp. | 1 | 0 | 2 | |
| Candida spp. (n = 32) | 13 (10.2) | 6 (5.6) | 13 (8.2) | 0.58 |
| Candida albicans | 6 | 5 | 2 | |
| Candida glabrata | 4 | 1 | 9 | |
| Candida krusei | 1 | 0 | 0 | |
| Candida parapsilosis | 1 | 0 | 1 | |
| Candida tropicalis | 1 | 0 | 1 | |
| Treatment-related outcomes | ||||
| Time to effective therapy, h, median (IQR) | 15.0 (4.3–25.7) | 13.0 (4.3–23.1) | 4.9 (1.0–19.6)b,c | <0.001 |
| Repeat positive blood cultures | 21/118 (17.8) | 11/103 (10.7) | 25/155 (16.1) | 0.31 |
| Microbiologic clearance within 3 days after blood culture draw | 100/127 (78.7) | 90/108 (83.3) | 128/159 (80.5) | 0.67 |
| Clinical outcomes | ||||
| Length of hospitalization (LOS), no. of days, median (IQR) (n = 319) | 12 (7–20) | 9 (6–18) | 11 (7–24) | 0.33 |
| LOS, no. of days, following index blood culture collection, median (IQR) (n = 319) | 8.4 (5.5–15.6) | 7.8 (5.1–14.8) | 8.2 (5.2–15.9) | 0.88 |
| In-hospital mortality (all cause) | 13 (11.3) | 12 (11.5) | 20 (13.8) | 0.80 |
| Infection-related mortality | 7 (6.1) | 8 (7.7) | 13 (9.0) | 0.69 |
| 30-day all-cause hospital readmission (n = 319) | 26 (25.5) | 24 (26.1) | 23 (18.4) | 0.31 |
| Relapse of bacteremia | 6 (5.2) | 4 (3.8) | 4 (2.7) | 0.59 |
| Total hospital costs (per patient), $, mean (median) | 57,442 (27,564) | 58,306 (21,222) | 47,992 (23,840) | 0.26 |
a
Data are presented as number (percent) of patients, unless specified otherwise. Abbreviations: BCID, blood culture identification panel; IQR, interquartile range; VRE, vancomycin-resistant enterococci.
b
Statistically significant compared to control group.
c
Statistically significant comparison between the 2 intervention groups.