title: Influence of automated screening and confirmation of extended-spectrum beta-lactamase-producing members of the Enterobacteriaceae on prescribing of antibiotics.
abstract: This study investigated the clinician response to the extended-spectrum beta-lactamase (ESBL) confirmation report generated by an automated detection system, MicroScan Walkaway. The study compared two cohorts (pre- and post-automated detection) of patients with an ESBL-producing Escherichia coli or Klebsiella species non-urinary infection over the period October 2001-December 2006. Acceptance of the report, as defined by the initiation of carbapenem therapy, was observed in 69.2% of the post-automated detection cohort (n=78) versus 20% in the pre-automated detection period (n=15) (P<or=0.001). The utilization of a carbapenem increased progressively over the course of the study. Moreover, the time to initiation of carbapenem therapy was reduced from 15.7+/-4.9 to 0.1+/-2.0 days (P<or=0.001) after implementation of this automated detection system. Overall, clinicians responded positively to the ESBL automated detection report, as gauged by the increased utilization of a carbapenem and the earlier initiation of appropriate therapy; however, reductions in length of stay and mortality were not observed in this infected population.
authors: Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT 06102, USA.
authors: Anthony M
authors: AM
authors: Nicasio
authors: Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT 06102, USA.
authors: Joseph L
authors: JL
authors: Kuti
authors: Division of Clinical Microbiology, Hartford Hospital, Hartford, CT 06102, USA.
authors: Jaber
authors: J
authors: Aslanzadeh
authors: Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT 06102, USA.
authors: David P
authors: DP
authors: Nicolau
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001331:Automation; D015780:Carbapenems / Q000627:therapeutic use; D015331:Cohort Studies; D011307:Drug Prescriptions; D004363:Drug Utilization; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D001618:beta-Lactamases