Skip to main content Accessibility help
×
Home

Automated Alerts Coupled with Antimicrobial Stewardship Intervention Lead to Decreases in Length of Stay in Patients with Gram-Negative Bacteremia

  • Jason M. Pogue (a1) (a2), Ryan P. Mynatt (a3), Dror Marchaim (a2), Jing J. Zhao (a4), Viktorija O. Barr (a3), Judy Moshos (a5), Bharath Sunkara (a2), Teena Chopra (a2) (a6), Sowmya Chidurala (a2) and Keith S. Kaye (a2) (a6)...

Abstract

Objective.

To assess the impact of active alerting of positive blood culture data coupled with stewardship intervention on time to appropriate therapy, length of stay, and mortality in patients with gram-negative bacteremia.

Design.

Quasi-experimental retrospective cohort study in patients with gram-negative bacteremia at the Detroit Medical Center from 2009 to 2011.

Setting.

Three hospitals (1 community, 2 academic) with active antimicrobial stewardship programs within the Detroit Medical Center.

Patients.

All patients with monomicrobial gram-negative bacteremia during the study period.

Intervention.

Active alerting of positive blood culture data coupled with stewardship intervention (2010-2011) compared with patients who received no formalized stewardship intervention (2009).

Results.

Active alerting and intervention led to a decreased time to appropriate therapy (8 [interquartile range (IQR), 2-24] vs 14 [IQR, 2-35] hours; P = .014) in patients with gram-negative bacteremia. After controlling for differences between groups, being in the intervention arm was associated with an independent reduction in length of stay (odds ratio [OR], 0.73 [95% confidence interval (CI), 0.62-0.86]), correlating to a median attributable decrease in length of stay of 2.2 days. Additionally, multivariate modeling of patients who were not on appropriate antimicrobial therapy at the time of initial culture positivity showed that patients in the intervention group had a significant reduction in both length of stay (OR, 0.76 [95% CI, 0.66-0.86]) and infection-related mortality (OR, 0.24 [95% CI, 0.08-0.76]).

Conclusions.

Active alerting coupled with stewardship intervention in patients with gram-negative bacteremia positively impacted time to appropriate therapy, length of stay, and mortality and should be a target of antimicrobial stewardship programs.

Copyright

Corresponding author

Sinai-Grace Hospital, Detroit Medical Center, 6071 West Outer Drive, Detroit, MI 48235 (jpogue@dmc.org)

References

Hide All
1. Dellit, TH, Owens, RC, Mcgowan, JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44: 159177.
2. Leibovici, L, Shraga, I, Drucker, M, Konigsberger, H, Samra, Z, Pitlik, SD. The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998; 244(5):379386.
3. Micek, ST, Welch, EC, Khan, J, et al. Resistance to empiric antimicrobial treatment predicts outcome in severe sepsis associated with gram-negative bacteremia. J Hosp Med 2011;6(7):405410.
4. Kumar, A, Roberts, D, Wood, KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:15891596.
5. Holtzman, C, Whitney, D, Barlam, T, Miller, NS. Assessment of impact of peptide nucleic acid fluorescence in situ hybridization for identification of coagulase-negative staphylococci in the absence of antimicrobial stewardship intervention. J Clin Microbiol 2011;49(4):15811582.
6. Perez, KK, Olsen, RJ, Musick, WL, et al. Integrating rapid pathogen identification and antimicrobial stewardship significantly decreases hospital costs. Arch Pathol Lab Med 2013;137(9):12471254.
7. Bauer, KA, West, JE, Balada-Llast, JM, et al. An antimicrobial stewardship program's impact with rapid polymerase chain reaction methicillin-resistant Staphylococcus aureus/S. aureus blood culture test in patients with S. aureus bacteremia. Clin Infect Dis 2010;51(9):10741080.
8. Wong, JR, Bauer, KA, Mangino, JE, Goff, DA. Antimicrobial stewardship pharmacist interventions for coagulase-negative staphylococci positive blood cultures using rapid polymerase chain reaction. Ann Pharmacother 2012;46(11):14841490.
9. Nowak, MA, Nelson, RE, Breidenbach, JL, et al. Clinical and economic outcomes of a prospective antimicrobial stewardship program. Am J Health Syst Pharm 2012;69(17):15001508.
10. Rullar, R, Davis, SL, Kaye, KS, et al. Implementation of an antimicrobial stewardship pathway with daptomycin for optimal treatment of methicillin-resistant Staphylococcus aureus bacteremia. Pharmacotherapy 2013;33(1):310.
11. Malani, AN, Richards, PG, Rapila, S, et al. Clinical and economic outcomes from a community hospital's antimicrobial stewardship program. Am J Infect Control 2013;41(2):145148.

Automated Alerts Coupled with Antimicrobial Stewardship Intervention Lead to Decreases in Length of Stay in Patients with Gram-Negative Bacteremia

  • Jason M. Pogue (a1) (a2), Ryan P. Mynatt (a3), Dror Marchaim (a2), Jing J. Zhao (a4), Viktorija O. Barr (a3), Judy Moshos (a5), Bharath Sunkara (a2), Teena Chopra (a2) (a6), Sowmya Chidurala (a2) and Keith S. Kaye (a2) (a6)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed