Automated alerts coupled with antimicrobial stewardship intervention lead to decreases in length of stay in patients with gram-negative bacteremia.
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.


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


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


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


METHODS
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.
Department of Pharmacy, Sinai-Grace Hospital, Detroit Medical Center, Detroit, Michigan.
Jason M
JM
Pogue
Ryan P
RP
Mynatt
Dror
D
Marchaim
Jing J
JJ
Zhao
Viktorija O
VO
Barr
Judy
J
Moshos
Bharath
B
Sunkara
Teena
T
Chopra
Sowmya
S
Chidurala
Keith S
KS
Kaye
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D017723:Drug Utilization Review; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017010:Reminder Systems; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents