Impact of a Laboratory-Developed Phenotypic Rapid Susceptibility Test Directly From Positive Blood Cultures on Time to Narrowest Effective Therapy in Patients With Gram-Negative Bacteremia: A Prospective Randomized Trial.

Authors

Alyssa B Christensen, Providence Health & Services, Portland, OR.Follow
Brent Footer, Antimicrobial Stewardship Program, Providence Health and Services, Portland, OR, USA.Follow
Tobias Pusch, Department of Internal Medicine, Section of Infectious Diseases, Providence St. Vincent Medical Center, Portland, OR, USAFollow
Kim Heath, Department of Clinical Microbiology, Providence Oregon Regional Laboratory, Portland, Oregon, USA.Follow
Maha Iqbal, Department of Clinical Microbiology, Providence Oregon Regional Laboratory, Portland, Oregon, USA.Follow
Lian Wang, Medical Data Research Center, Providence Health and Services, Portland, OR, USAFollow
Gregory Tallman, Department of Pharmacy, Providence St Vincent Medical Center, Portland, Oregon, USA.Follow
Cameron J Cover, Department of Internal Medicine, Section of Infectious Diseases, Providence St. Vincent Medical Center, Portland, OR, USAFollow
Jennifer Marfori, Providence St. Vincent, Portland, OregonFollow
Brian A Kendall, Antimicrobial Stewardship Program, Providence Health and Services, Portland, OR, USA.Follow
Nicholas L Stucky, Antimicrobial Stewardship Program, Providence Health and Services, Portland, OR, USA.Follow
Meagan Greckel, Providence Portland Medical CenterFollow
Ivor Thomas, Providence Portland Medical CenterFollow
Katelynn Tran, Department of Pharmacy, Providence St Vincent Medical Center, Portland, Oregon, USA.Follow
Salena Yip, Department of Pharmacy, Providence St Vincent Medical Center, Portland, Oregon, USA.
Margret Oethinger, Clinical Care and Personalized Health, Providence St. Joseph Health, Renton, Washington, USA.Follow

Document Type

Article

Publication Date

7-1-2022

Publication Title

Open Forum Infect Dis

Keywords

oregon; portland; cards; cards publication; psvmc; ppmc; prn

Abstract

Background: Antimicrobial susceptibility testing (AST) is often needed prior to antimicrobial optimization for patients with gram-negative bloodstream infections (GN-BSIs). Rapid AST (rAST) in combination with antimicrobial stewardship (AS) may decrease time to administration of narrower antibiotics.

Methods: This was a prospective, nonblinded, randomized trial evaluating the impact of a phenotypic rAST method vs conventional AST (cAST) in hospitalized patients with GN-BSI and source control. The primary outcome was time to narrowest effective therapy.

Results: Two hundred seventy-four patients were randomized and 205 underwent analysis (97 cAST, 108 rAST). Median (interquartile range [IQR]) time to susceptibility results was 23 hours shorter in the rAST group (cAST: 62 [59-67] hours vs rAST: 39 [IQR, 35-46] hours;

Conclusions: In patients with GN-BSI, rAST did not significantly decrease time to narrowest effective therapy but did decrease time to oral antibiotics and length of hospital stay. Rapid AST using existing microbiology platforms has potential to optimize patient outcomes.

Department

Pharmacy

Department

Infectious Diseases

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