Abstract
Background
Rapid diagnostic testing can identify bacterial pathogens and genetic markers of resistance. This information can aid in deescalating antimicrobial therapy based on local patterns prior to the return of final culture and susceptibility reports. In August of 2017 at our institution, pharmacists were incorporated in the review of these rapid diagnostic tests in real time with recommendations for changes to therapy paged to providers. The purpose of this study was to determine whether the inclusion of a pharmacist in this workflow reduces time to change in antimicrobial therapy.
Methods
This retrospective study over two periods in 2016 and 2018 analyzed the pre- and post-implementation of a workflow incorporating pharmacist review of positive blood cultures analyzed by rapid molecular assay. Patients were included if they were at least 18 years of age and were initiated on empiric antibiotics prior to test results. Patients were excluded if transitioned to hospice within 24 hours of test results, discharged prior to test results, if more than one infectious process or organism was identified, or if test results were positive for coagulase-negative staphylococci. The primary outcome of the study was the time to change to targeted antimicrobials. Secondary outcomes were rates of Clostridium difficile infection within 3 months and inpatient mortality. Categorical variables were evaluated using chi-squared or Fisher exact tests, and continuous variables were evaluated using Wilcoxon rank-sum tests.
Results
A total of 199 patients were included, with 98 and 101 patients in the pre- and post-implementation groups, respectively. The median time to change to targeted antimicrobials was significantly reduced with pharmacist intervention from 18.35 to 8.43 hours (P = 0.042). The groups had similar rates of C. difficile infection (1% vs. 0%, P = 0.492) and mortality (7.1% vs. 5%, P = 0.564). The post-group also had significant reductions in antibiotic days of therapy (10.5 vs. 9 days, P = 0.014) and intensive-care unit length of stay (3.04 vs. 1.44 days, P = 0.046).
Conclusion
Incorporating pharmacist review of rapid molecular results of blood cultures decreased time to change in antimicrobial regimen and reduced antibiotic days of therapy.
Disclosures
All authors: No reported disclosures.
Session: 235. Antibiotic Stewardship: Diagnostics and Diagnostic Stewardship
Saturday, October 5, 2019: 12:15 PM