Incorporation of rapid diagnostic tests to improve time to antimicrobial therapy for gram-positive bacteremia and candidemia

Leroy Koh; Punit J. Shah; Aileen Korulla; Gordana Jasmak; Oyejoke Fasoranti; Charles Janak; Katherine Perez

doi:10.1093/ajhp/zxaa030

Incorporation of rapid diagnostic tests to improve time to antimicrobial therapy for gram-positive bacteremia and candidemia

Leroy Koh, Punit J. Shah, Aileen Korulla, Gordana Jasmak, Oyejoke Fasoranti, Charles Janak, Katherine Perez

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

PURPOSE: Even with rapid diagnostic technology to swiftly identify infectious organisms, prompt response is needed to translate results into appropriate actions. The purpose of this study was to determine if the introduction of real-time pharmacist response to positive rapid diagnostic test results would decrease time to antimicrobial therapy for gram-positive bacteremia and candidemia in a community hospital setting.

METHODS: A quasi-experimental study was conducted in 2 community hospitals. The study comprised 2 cohorts of adult patients who tested positive for gram-positive bacteremia involving Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, or Candida species. The preintervention cohort consisted of patients admitted from November 2017 through May 2018. The intervention cohort consisted of patients admitted from July 2018 through January 2019, after the intervention went live. The primary outcomes were time to optimal antimicrobial therapy and time to effective antimicrobial therapy.

RESULTS: A total of 140 patients were included in the preintervention group, with 124 patients included in the intervention group. The mean (SD) time to effective therapy decreased from 13.9 (21.6) hours in the preintervention group to 8.6 (12.5) hours in the intervention group (hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.89-1.48; P = 0.29). The mean (SD) time to optimal therapy significantly decreased from 53.7 (57.7) hours in the preintervention group to 38.4 (31.5) hours in the intervention group (HR, 1.73; 95% CI, 1.33-2.26; P < 0.001).

CONCLUSION: The introduction of real-time pharmacist response to positive rapid diagnostic test results led to a significant decrease in time to optimal antimicrobial therapy but did not significantly affect time to effective therapy. The results showed that the allocation of limited resources of a community hospital to such a stewardship program is justifiable.

Original language	English (US)
Pages (from-to)	622-631
Number of pages	10
Journal	American Journal of Health-System Pharmacy
Volume	77
Issue number	8
DOIs	https://doi.org/10.1093/ajhp/zxaa030
State	Published - Apr 1 2020

Keywords

Antimicrobial therapy
Community hospital
Pharmacist
Prospective review
Rapid diagnostic technology
Time to therapy
Length of Stay
Humans
Middle Aged
Male
Anti-Infective Agents/administration & dosage
Microbiological Techniques/standards
Time-to-Treatment/statistics & numerical data
Aged, 80 and over
Adult
Female
Aged
Bacteremia/drug therapy
Pharmacy Service, Hospital/organization & administration
Hospitals, Community/statistics & numerical data
Candidemia/drug therapy

ASJC Scopus subject areas

Health Policy
Pharmacy
Pharmacology

Access to Document

10.1093/ajhp/zxaa030

Cite this

@article{68e9dbd59f3b4a919507daf171df3328,

title = "Incorporation of rapid diagnostic tests to improve time to antimicrobial therapy for gram-positive bacteremia and candidemia",

abstract = "PURPOSE: Even with rapid diagnostic technology to swiftly identify infectious organisms, prompt response is needed to translate results into appropriate actions. The purpose of this study was to determine if the introduction of real-time pharmacist response to positive rapid diagnostic test results would decrease time to antimicrobial therapy for gram-positive bacteremia and candidemia in a community hospital setting.METHODS: A quasi-experimental study was conducted in 2 community hospitals. The study comprised 2 cohorts of adult patients who tested positive for gram-positive bacteremia involving Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, or Candida species. The preintervention cohort consisted of patients admitted from November 2017 through May 2018. The intervention cohort consisted of patients admitted from July 2018 through January 2019, after the intervention went live. The primary outcomes were time to optimal antimicrobial therapy and time to effective antimicrobial therapy.RESULTS: A total of 140 patients were included in the preintervention group, with 124 patients included in the intervention group. The mean (SD) time to effective therapy decreased from 13.9 (21.6) hours in the preintervention group to 8.6 (12.5) hours in the intervention group (hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.89-1.48; P = 0.29). The mean (SD) time to optimal therapy significantly decreased from 53.7 (57.7) hours in the preintervention group to 38.4 (31.5) hours in the intervention group (HR, 1.73; 95% CI, 1.33-2.26; P < 0.001).CONCLUSION: The introduction of real-time pharmacist response to positive rapid diagnostic test results led to a significant decrease in time to optimal antimicrobial therapy but did not significantly affect time to effective therapy. The results showed that the allocation of limited resources of a community hospital to such a stewardship program is justifiable.",

keywords = "Antimicrobial therapy, Community hospital, Pharmacist, Prospective review, Rapid diagnostic technology, Time to therapy, Length of Stay, Humans, Middle Aged, Male, Anti-Infective Agents/administration & dosage, Microbiological Techniques/standards, Time-to-Treatment/statistics & numerical data, Aged, 80 and over, Adult, Female, Aged, Bacteremia/drug therapy, Pharmacy Service, Hospital/organization & administration, Hospitals, Community/statistics & numerical data, Candidemia/drug therapy",

author = "Leroy Koh and Shah, {Punit J.} and Aileen Korulla and Gordana Jasmak and Oyejoke Fasoranti and Charles Janak and Katherine Perez",

year = "2020",

month = apr,

day = "1",

doi = "10.1093/ajhp/zxaa030",

language = "English (US)",

volume = "77",

pages = "622--631",

journal = "American Journal of Health-System Pharmacy",

issn = "1079-2082",

publisher = "American Society of Health-Systems Pharmacy",

number = "8",

}

TY - JOUR

T1 - Incorporation of rapid diagnostic tests to improve time to antimicrobial therapy for gram-positive bacteremia and candidemia

AU - Koh, Leroy

AU - Shah, Punit J.

AU - Korulla, Aileen

AU - Jasmak, Gordana

AU - Fasoranti, Oyejoke

AU - Janak, Charles

AU - Perez, Katherine

PY - 2020/4/1

Y1 - 2020/4/1

N2 - PURPOSE: Even with rapid diagnostic technology to swiftly identify infectious organisms, prompt response is needed to translate results into appropriate actions. The purpose of this study was to determine if the introduction of real-time pharmacist response to positive rapid diagnostic test results would decrease time to antimicrobial therapy for gram-positive bacteremia and candidemia in a community hospital setting.METHODS: A quasi-experimental study was conducted in 2 community hospitals. The study comprised 2 cohorts of adult patients who tested positive for gram-positive bacteremia involving Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, or Candida species. The preintervention cohort consisted of patients admitted from November 2017 through May 2018. The intervention cohort consisted of patients admitted from July 2018 through January 2019, after the intervention went live. The primary outcomes were time to optimal antimicrobial therapy and time to effective antimicrobial therapy.RESULTS: A total of 140 patients were included in the preintervention group, with 124 patients included in the intervention group. The mean (SD) time to effective therapy decreased from 13.9 (21.6) hours in the preintervention group to 8.6 (12.5) hours in the intervention group (hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.89-1.48; P = 0.29). The mean (SD) time to optimal therapy significantly decreased from 53.7 (57.7) hours in the preintervention group to 38.4 (31.5) hours in the intervention group (HR, 1.73; 95% CI, 1.33-2.26; P < 0.001).CONCLUSION: The introduction of real-time pharmacist response to positive rapid diagnostic test results led to a significant decrease in time to optimal antimicrobial therapy but did not significantly affect time to effective therapy. The results showed that the allocation of limited resources of a community hospital to such a stewardship program is justifiable.

AB - PURPOSE: Even with rapid diagnostic technology to swiftly identify infectious organisms, prompt response is needed to translate results into appropriate actions. The purpose of this study was to determine if the introduction of real-time pharmacist response to positive rapid diagnostic test results would decrease time to antimicrobial therapy for gram-positive bacteremia and candidemia in a community hospital setting.METHODS: A quasi-experimental study was conducted in 2 community hospitals. The study comprised 2 cohorts of adult patients who tested positive for gram-positive bacteremia involving Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, or Candida species. The preintervention cohort consisted of patients admitted from November 2017 through May 2018. The intervention cohort consisted of patients admitted from July 2018 through January 2019, after the intervention went live. The primary outcomes were time to optimal antimicrobial therapy and time to effective antimicrobial therapy.RESULTS: A total of 140 patients were included in the preintervention group, with 124 patients included in the intervention group. The mean (SD) time to effective therapy decreased from 13.9 (21.6) hours in the preintervention group to 8.6 (12.5) hours in the intervention group (hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.89-1.48; P = 0.29). The mean (SD) time to optimal therapy significantly decreased from 53.7 (57.7) hours in the preintervention group to 38.4 (31.5) hours in the intervention group (HR, 1.73; 95% CI, 1.33-2.26; P < 0.001).CONCLUSION: The introduction of real-time pharmacist response to positive rapid diagnostic test results led to a significant decrease in time to optimal antimicrobial therapy but did not significantly affect time to effective therapy. The results showed that the allocation of limited resources of a community hospital to such a stewardship program is justifiable.

KW - Antimicrobial therapy

KW - Community hospital

KW - Pharmacist

KW - Prospective review

KW - Rapid diagnostic technology

KW - Time to therapy

KW - Length of Stay

KW - Humans

KW - Middle Aged

KW - Male

KW - Anti-Infective Agents/administration & dosage

KW - Microbiological Techniques/standards

KW - Time-to-Treatment/statistics & numerical data

KW - Aged, 80 and over

KW - Adult

KW - Female

KW - Aged

KW - Bacteremia/drug therapy

KW - Pharmacy Service, Hospital/organization & administration

KW - Hospitals, Community/statistics & numerical data

KW - Candidemia/drug therapy

UR - http://www.scopus.com/inward/record.url?scp=85082779512&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85082779512&partnerID=8YFLogxK

U2 - 10.1093/ajhp/zxaa030

DO - 10.1093/ajhp/zxaa030

M3 - Article

C2 - 32123897

AN - SCOPUS:85082779512

SN - 1079-2082

VL - 77

SP - 622

EP - 631

JO - American Journal of Health-System Pharmacy

JF - American Journal of Health-System Pharmacy

IS - 8

ER -

Incorporation of rapid diagnostic tests to improve time to antimicrobial therapy for gram-positive bacteremia and candidemia

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this