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Impact of antimicrobial stewardship and rapid microarray testing on patients with Gram-negative bacteremia

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

A rapid microarray assay, Nanosphere Verigene® Gram-negative blood culture test (BC-GN), detects four Gram-negative species, four Gram-negative genera, and six resistance genes directly from positive blood culture samples, shortening the time from Gram stain to pathogen and resistance-gene identification. The purpose of this study was to determine the impact of the BC-GN paired with an antimicrobial stewardship intervention on antimicrobial and clinical outcomes. Patients with Gram-negative bacteremia were compared before (n = 456) and after (n = 421) BC-GN implementation. The primary objective was to compare time from Gram stain to antimicrobial switch pre- and post-implementation. Time from Gram stain to effective treatment, in-hospital mortality, and hospital length of stay were also compared. The number and type of antimicrobial switches were similar between groups. Median (IQR) time from Gram stain to antimicrobial switch was significantly decreased in the post group, 28.6 (8.6–56.9) h vs 44.1 (18.9–64.6) h, p = 0.004. In patients on ineffective antimicrobial therapy at the time of result, median time to effective therapy was lower in the post group, 8.8 (5.5–18.4) h vs 24.5 (4.9–44.3) h, p = 0.034. Median (IQR) hospital length of stay was also decreased in the post group, 7 (5–15) days vs 9 (4.5–21) days, p = 0.001. The rate of in-hospital mortality was similar between groups, 11.6% (pre) vs 11.4% (post), p = 0.87. Rapid microarray testing on blood cultures combined with active antimicrobial stewardship intervention was associated with decreased time to antimicrobial switch, time to effective therapy, and hospital length of stay.

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Authors and Affiliations

  1. Department of Pharmacy, Cleveland Clinic, 9500 Euclid Ave/Hb-105, Cleveland, OH, 44195, USA

    K. R. Rivard, V. Athans, S. W. Lam & E. Neuner

  2. Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA

    S. M. Gordon

  3. Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA

    G. W. Procop & S. S. Richter

Authors
  1. K. R. Rivard
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  2. V. Athans
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  3. S. W. Lam
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  4. S. M. Gordon
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  5. G. W. Procop
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  6. S. S. Richter
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  7. E. Neuner
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Corresponding author

Correspondence to K. R. Rivard.

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Funding

No funding was received to conduct this study.

Conflicts of interest

S.S.R. receives research funding from Nanosphere and BioMerieux.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

The study protocol was approved by the Cleveland Clinic Health System institutional review board, which waived the requirement for informed consent due to the retrospective nature of the evaluation.

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Appendix

Appendix

Table 5 Institutional guidelines for treatment of Gram-negative bacilli from blood cultures
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Rivard, K.R., Athans, V., Lam, S.W. et al. Impact of antimicrobial stewardship and rapid microarray testing on patients with Gram-negative bacteremia. Eur J Clin Microbiol Infect Dis 36, 1879–1887 (2017). https://doi.org/10.1007/s10096-017-3008-6

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  • DOI: https://doi.org/10.1007/s10096-017-3008-6

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