The effect of rapid diagnostic testing with Infectious Diseases fellow consultative intervention on the management of enterococcal bloodstream infection

Diagn Microbiol Infect Dis. 2018 Dec;92(4):319-324. doi: 10.1016/j.diagmicrobio.2018.07.004. Epub 2018 Jul 9.

Abstract

Background: Rapid diagnostics for enterococcal bloodstream infections (E-BSIs) can decrease the time to speciation and determination of vancomycin resistance but may not lead to improved antibiotic stewardship.

Methods: Over 3 years, the time to administration of institutionally preferred antibiotics (IPT) for patients with E-BSI was evaluated and compared between 3 intervention groups: before (baseline) and after implementation of a rapid diagnostic (BC-GP), and the use of BC-GP with an Infectious Diseases (ID) fellow-driven consultative intervention (BC-GP + ID).

Results: A total of 110 patients (63 baseline, 13 BC-GP, 34 BC-GP + ID) with E-BSI were evaluated. Evaluation of Enterococcus faecium BSI showed that the time IPT was significantly reduced with BC-GP + ID by 10.6 h from baseline (P = 0.02) and 5.4 h from BC-GP (P = 0.04).

Conclusions: An ID fellow-driven stewardship intervention was associated with a significant improvement in time to IPT for patients with E. faecium but not E. faecalis BSI.

Keywords: Bloodstream infection; Enterococcus; Infectious disease fellows; Rapid diagnostics; Stewardship.

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia*
  • Blood Culture
  • Enterococcus* / classification
  • Enterococcus* / drug effects
  • Enterococcus* / genetics
  • Gram-Positive Bacterial Infections / diagnosis*
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / microbiology*
  • Gram-Positive Bacterial Infections / mortality
  • Humans
  • In Situ Hybridization, Fluorescence
  • Molecular Diagnostic Techniques*
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents