Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time
OBJECTIVE To assess the impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) mass spectrometry for rapid pathogen identification directly from early-positive blood cultures coupled with an antimicrobial stewardship program (ASP) in two community hospitals. Process measure...
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| Veröffentlicht in: | Infection control and hospital epidemiology 2016-04, Vol.37 (4), p.425-432 |
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| creator | Lockwood, Ashley M. Perez, Katherine K. Musick, William L. Ikwuagwu, Judy O. Attia, Engie Fasoranti, Oyejoke O. Cernoch, Patricia L. Olsen, Randall J. Musser, James M. |
| description | OBJECTIVE To assess the impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) mass spectrometry for rapid pathogen identification directly from early-positive blood cultures coupled with an antimicrobial stewardship program (ASP) in two community hospitals. Process measures and outcomes prior and after implementation of MALDI-TOF/ASP were evaluated. DESIGN Multicenter retrospective study. SETTING Two community hospitals in a system setting, Houston Methodist (HM) Sugar Land Hospital (235 beds) or HM Willowbrook Hospital (241 beds). PATIENTS Patients ≥ 18 years of age with culture-proven Gram-negative bacteremia. INTERVENTION Blood cultures from both hospitals were sent to and processed at our central microbiology laboratory. Clinical pharmacists at respective hospitals were notified of pathogen ID and susceptibility results. RESULTS We evaluated 572 patients for possible inclusion. After pre-defined exclusion criteria, 151 patients were included in the pre-intervention group and 242 were included in the intervention group. After MALDI-TOF/ASP implementation, the mean identification time after culture positivity was significantly reduced from 32 hours (±16 hours) to 6.5 hours (±5.4 hours) (P |
| doi_str_mv | 10.1017/ice.2015.313 |
| format | Article |
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Process measures and outcomes prior and after implementation of MALDI-TOF/ASP were evaluated. DESIGN Multicenter retrospective study. SETTING Two community hospitals in a system setting, Houston Methodist (HM) Sugar Land Hospital (235 beds) or HM Willowbrook Hospital (241 beds). PATIENTS Patients ≥ 18 years of age with culture-proven Gram-negative bacteremia. INTERVENTION Blood cultures from both hospitals were sent to and processed at our central microbiology laboratory. Clinical pharmacists at respective hospitals were notified of pathogen ID and susceptibility results. RESULTS We evaluated 572 patients for possible inclusion. After pre-defined exclusion criteria, 151 patients were included in the pre-intervention group and 242 were included in the intervention group. After MALDI-TOF/ASP implementation, the mean identification time after culture positivity was significantly reduced from 32 hours (±16 hours) to 6.5 hours (±5.4 hours) (P<.001); mean time to susceptibility results was significantly reduced from 48 (±22) hours to 23 (±14) hours (P<.001); and time to therapy adjustment was significantly reduced from 75 (±59) hours to 30 (±30) hours (P<.001). Mean hospital costs per patient were $3,411 less in the intervention group compared with the pre-intervention group ($18,645 vs $15,234; P=.04). CONCLUSION This study is the first to analyze the impact of MALDI-TOF coupled with an ASP in a community hospital setting. Time to results significantly differed with the use of MALDI-TOF, and time to appropriate therapy was significantly improved with the addition of ASP.</description><identifier>ISSN: 0899-823X</identifier><identifier>EISSN: 1559-6834</identifier><identifier>DOI: 10.1017/ice.2015.313</identifier><identifier>PMID: 26738993</identifier><language>eng</language><publisher>New York, USA: Cambridge University Press</publisher><subject>Aged ; Aged, 80 and over ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Bacteremia - diagnosis ; Bacteremia - drug therapy ; Bacteriological Techniques ; Blood ; Demographics ; Drug stores ; Drug Utilization - standards ; Female ; Hospital costs ; Hospitals ; Hospitals, Community ; Humans ; Infectious diseases ; Intervention ; Ionization ; Length of stay ; Male ; Mass spectrometry ; Medical laboratories ; Microbiology ; Middle Aged ; Mortality ; Nosocomial infections ; Nursing ; Original Articles ; Pathogens ; Patients ; Retrospective Studies ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; Texas</subject><ispartof>Infection control and hospital epidemiology, 2016-04, Vol.37 (4), p.425-432</ispartof><rights>2016 by The Society for Healthcare Epidemiology of America. All rights reserved</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-178ab96533e3d3ce243259483f85291171eedac50c49665916de7a590e0d5d423</citedby><cites>FETCH-LOGICAL-c462t-178ab96533e3d3ce243259483f85291171eedac50c49665916de7a590e0d5d423</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2799891787/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2799891787?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>164,314,776,780,21367,27901,27902,33721,33722,43781,55603,74273</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26738993$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lockwood, Ashley M.</creatorcontrib><creatorcontrib>Perez, Katherine K.</creatorcontrib><creatorcontrib>Musick, William L.</creatorcontrib><creatorcontrib>Ikwuagwu, Judy O.</creatorcontrib><creatorcontrib>Attia, Engie</creatorcontrib><creatorcontrib>Fasoranti, Oyejoke O.</creatorcontrib><creatorcontrib>Cernoch, Patricia L.</creatorcontrib><creatorcontrib>Olsen, Randall J.</creatorcontrib><creatorcontrib>Musser, James M.</creatorcontrib><title>Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time</title><title>Infection control and hospital epidemiology</title><addtitle>Infect. Control Hosp. Epidemiol</addtitle><description>OBJECTIVE To assess the impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) mass spectrometry for rapid pathogen identification directly from early-positive blood cultures coupled with an antimicrobial stewardship program (ASP) in two community hospitals. Process measures and outcomes prior and after implementation of MALDI-TOF/ASP were evaluated. DESIGN Multicenter retrospective study. SETTING Two community hospitals in a system setting, Houston Methodist (HM) Sugar Land Hospital (235 beds) or HM Willowbrook Hospital (241 beds). PATIENTS Patients ≥ 18 years of age with culture-proven Gram-negative bacteremia. INTERVENTION Blood cultures from both hospitals were sent to and processed at our central microbiology laboratory. Clinical pharmacists at respective hospitals were notified of pathogen ID and susceptibility results. RESULTS We evaluated 572 patients for possible inclusion. After pre-defined exclusion criteria, 151 patients were included in the pre-intervention group and 242 were included in the intervention group. After MALDI-TOF/ASP implementation, the mean identification time after culture positivity was significantly reduced from 32 hours (±16 hours) to 6.5 hours (±5.4 hours) (P<.001); mean time to susceptibility results was significantly reduced from 48 (±22) hours to 23 (±14) hours (P<.001); and time to therapy adjustment was significantly reduced from 75 (±59) hours to 30 (±30) hours (P<.001). Mean hospital costs per patient were $3,411 less in the intervention group compared with the pre-intervention group ($18,645 vs $15,234; P=.04). CONCLUSION This study is the first to analyze the impact of MALDI-TOF coupled with an ASP in a community hospital setting. Time to results significantly differed with the use of MALDI-TOF, and time to appropriate therapy was significantly improved with the addition of ASP.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Bacteremia - diagnosis</subject><subject>Bacteremia - drug therapy</subject><subject>Bacteriological Techniques</subject><subject>Blood</subject><subject>Demographics</subject><subject>Drug stores</subject><subject>Drug Utilization - standards</subject><subject>Female</subject><subject>Hospital costs</subject><subject>Hospitals</subject><subject>Hospitals, Community</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Intervention</subject><subject>Ionization</subject><subject>Length of stay</subject><subject>Male</subject><subject>Mass spectrometry</subject><subject>Medical laboratories</subject><subject>Microbiology</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nosocomial infections</subject><subject>Nursing</subject><subject>Original Articles</subject><subject>Pathogens</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization</subject><subject>Texas</subject><issn>0899-823X</issn><issn>1559-6834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNptkc1uEzEUhS0EoqGwY40ssWHBBP-MZ8bLKPw0UhEIgsTO8tg3wVFsT20PVZ-CV8ZVA5UQKy_83e8e3YPQc0qWlND-jTOwZISKJaf8AVpQIWTTDbx9iBZkkLIZGP9-hp7kfCCE9FLSx-iMdT2vf3yBfm1CgX3SxYU9_qInZ_Fbp_ch5uJMxjpYvArFeWdSHJ0-4q8FrnWy-YebsAt4ex3xOno_B1du8EXMkyv6mPHGTyn-BIs_p2ggZ_wRdJ4T3CtHF-sKvLKHORcPoeCt8_AUPdrVeXh2es_Rt_fvtuuL5vLTh816ddmYtmOlof2gR9kJzoFbboC1nAnZDnw3CCYp7SmA1UYQ08quE5J2FnotJAFihW0ZP0ev7rw15tUMuSjvsoHjUQeIc1a070W18JZX9OU_6CHOKdR0itV7DrKG6Sv1-o6qh8o5wU5NyXmdbhQl6rYoVYtSt0WpWlTFX5yk8-jB_oX_NFOB5cmn_Zic3cP92v8afwOxy57q</recordid><startdate>20160401</startdate><enddate>20160401</enddate><creator>Lockwood, Ashley M.</creator><creator>Perez, Katherine K.</creator><creator>Musick, William L.</creator><creator>Ikwuagwu, Judy O.</creator><creator>Attia, Engie</creator><creator>Fasoranti, Oyejoke O.</creator><creator>Cernoch, Patricia L.</creator><creator>Olsen, Randall J.</creator><creator>Musser, James M.</creator><general>Cambridge University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20160401</creationdate><title>Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time</title><author>Lockwood, Ashley M. ; Perez, Katherine K. ; Musick, William L. ; Ikwuagwu, Judy O. ; Attia, Engie ; Fasoranti, Oyejoke O. ; Cernoch, Patricia L. ; Olsen, Randall J. ; Musser, James M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c462t-178ab96533e3d3ce243259483f85291171eedac50c49665916de7a590e0d5d423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Bacteremia - diagnosis</topic><topic>Bacteremia - drug therapy</topic><topic>Bacteriological Techniques</topic><topic>Blood</topic><topic>Demographics</topic><topic>Drug stores</topic><topic>Drug Utilization - standards</topic><topic>Female</topic><topic>Hospital costs</topic><topic>Hospitals</topic><topic>Hospitals, Community</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Intervention</topic><topic>Ionization</topic><topic>Length of stay</topic><topic>Male</topic><topic>Mass spectrometry</topic><topic>Medical laboratories</topic><topic>Microbiology</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Nosocomial infections</topic><topic>Nursing</topic><topic>Original Articles</topic><topic>Pathogens</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization</topic><topic>Texas</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lockwood, Ashley M.</creatorcontrib><creatorcontrib>Perez, Katherine K.</creatorcontrib><creatorcontrib>Musick, William L.</creatorcontrib><creatorcontrib>Ikwuagwu, Judy O.</creatorcontrib><creatorcontrib>Attia, Engie</creatorcontrib><creatorcontrib>Fasoranti, Oyejoke O.</creatorcontrib><creatorcontrib>Cernoch, Patricia L.</creatorcontrib><creatorcontrib>Olsen, Randall J.</creatorcontrib><creatorcontrib>Musser, James M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Infection control and hospital epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lockwood, Ashley M.</au><au>Perez, Katherine K.</au><au>Musick, William L.</au><au>Ikwuagwu, Judy O.</au><au>Attia, Engie</au><au>Fasoranti, Oyejoke O.</au><au>Cernoch, Patricia L.</au><au>Olsen, Randall J.</au><au>Musser, James M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time</atitle><jtitle>Infection control and hospital epidemiology</jtitle><addtitle>Infect. Control Hosp. Epidemiol</addtitle><date>2016-04-01</date><risdate>2016</risdate><volume>37</volume><issue>4</issue><spage>425</spage><epage>432</epage><pages>425-432</pages><issn>0899-823X</issn><eissn>1559-6834</eissn><abstract>OBJECTIVE To assess the impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) mass spectrometry for rapid pathogen identification directly from early-positive blood cultures coupled with an antimicrobial stewardship program (ASP) in two community hospitals. Process measures and outcomes prior and after implementation of MALDI-TOF/ASP were evaluated. DESIGN Multicenter retrospective study. SETTING Two community hospitals in a system setting, Houston Methodist (HM) Sugar Land Hospital (235 beds) or HM Willowbrook Hospital (241 beds). PATIENTS Patients ≥ 18 years of age with culture-proven Gram-negative bacteremia. INTERVENTION Blood cultures from both hospitals were sent to and processed at our central microbiology laboratory. Clinical pharmacists at respective hospitals were notified of pathogen ID and susceptibility results. RESULTS We evaluated 572 patients for possible inclusion. After pre-defined exclusion criteria, 151 patients were included in the pre-intervention group and 242 were included in the intervention group. After MALDI-TOF/ASP implementation, the mean identification time after culture positivity was significantly reduced from 32 hours (±16 hours) to 6.5 hours (±5.4 hours) (P<.001); mean time to susceptibility results was significantly reduced from 48 (±22) hours to 23 (±14) hours (P<.001); and time to therapy adjustment was significantly reduced from 75 (±59) hours to 30 (±30) hours (P<.001). Mean hospital costs per patient were $3,411 less in the intervention group compared with the pre-intervention group ($18,645 vs $15,234; P=.04). CONCLUSION This study is the first to analyze the impact of MALDI-TOF coupled with an ASP in a community hospital setting. Time to results significantly differed with the use of MALDI-TOF, and time to appropriate therapy was significantly improved with the addition of ASP.</abstract><cop>New York, USA</cop><pub>Cambridge University Press</pub><pmid>26738993</pmid><doi>10.1017/ice.2015.313</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use Antibiotics Bacteremia - diagnosis Bacteremia - drug therapy Bacteriological Techniques Blood Demographics Drug stores Drug Utilization - standards Female Hospital costs Hospitals Hospitals, Community Humans Infectious diseases Intervention Ionization Length of stay Male Mass spectrometry Medical laboratories Microbiology Middle Aged Mortality Nosocomial infections Nursing Original Articles Pathogens Patients Retrospective Studies Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization Texas |
| title | Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time |
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