title: Antibiotic utilization improvement with the Nanosphere Verigene Gram-Positive Blood Culture assay.
abstract: New technologies offer rapid identification of organisms and antimicrobial resistance markers in blood cultures several hours faster than conventional methods. We sought to determine whether implementation of the Verigene® Gram-Positive Blood Culture (BC-GP) assay paired with a well-defined results reporting algorithm would lead to earlier deescalation of empiric therapy for inpatients with methicillin-sensitive Staphylococcus aureus (MSSA) and vancomycin-resistant Enterococcus (VRE) bacteremia. The algorithm design focused on lessening the demand for pharmacist time by using electronic communications where possible. Our study compared inpatients with MSSA and VRE bacteremia from the time period before (pre-BC-GP) and after (post-BC-GP) implementation of the assay on June 25, 2013. The time from blood draw to identification and susceptibility results was decreased by 36.4 hours (P < 0.001) in the post-BC-GP group. The mean time from collection to the first dose of optimal antibiotics was reduced in the post-BC-GP group by 18.9 hours (P = 0.004) overall, with a 20.6-hour reduction (P = 0.009) for patients with MSSA and a 20.7-hour reduction (P = 0.077) for patients with VRE. Additionally, the percent of patients on empiric therapy who were placed on optimal antibiotics at any time after the Gram stain result was available increased from 64% (45/70) pre-BC-GP to 80% (43/54) post-BC-GP. The BC-GP led to an increased rate of deescalation of empiric antibiotics and a reduction in the time to optimal antibiotics for patients with MSSA and VRE bacteremia.
authors.affiliation: Department of Pathology and Laboratory Medicine (Beal, Thomas, Dekmezian, Benavides) and the Department of Pharmacy (Nguyen), Baylor University Medical Center at Dallas; med fusion Laboratory, Lewisville, Texas (Beal, Thomas, Dhiman, Dekmezian, Benavides); the Department of Quantitative Science, Baylor Health Care System, Dallas, Texas (Qin); and Baylor Research Institute, Dallas, Texas (Hawkins). Dr. Beal is now affiliated with the University of Florida Health Shands, Gainesville, Florida.
authors.forename: Stacy G
authors.initials: SG
authors.lastname: Beal
authors.affiliation: Department of Pathology and Laboratory Medicine (Beal, Thomas, Dekmezian, Benavides) and the Department of Pharmacy (Nguyen), Baylor University Medical Center at Dallas; med fusion Laboratory, Lewisville, Texas (Beal, Thomas, Dhiman, Dekmezian, Benavides); the Department of Quantitative Science, Baylor Health Care System, Dallas, Texas (Qin); and Baylor Research Institute, Dallas, Texas (Hawkins). Dr. Beal is now affiliated with the University of Florida Health Shands, Gainesville, Florida.
authors.forename: Cody
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Department of Pathology and Laboratory Medicine (Beal, Thomas, Dekmezian, Benavides) and the Department of Pharmacy (Nguyen), Baylor University Medical Center at Dallas; med fusion Laboratory, Lewisville, Texas (Beal, Thomas, Dhiman, Dekmezian, Benavides); the Department of Quantitative Science, Baylor Health Care System, Dallas, Texas (Qin); and Baylor Research Institute, Dallas, Texas (Hawkins). Dr. Beal is now affiliated with the University of Florida Health Shands, Gainesville, Florida.
authors.forename: Neelam
authors.initials: N
authors.lastname: Dhiman
authors.affiliation: Department of Pathology and Laboratory Medicine (Beal, Thomas, Dekmezian, Benavides) and the Department of Pharmacy (Nguyen), Baylor University Medical Center at Dallas; med fusion Laboratory, Lewisville, Texas (Beal, Thomas, Dhiman, Dekmezian, Benavides); the Department of Quantitative Science, Baylor Health Care System, Dallas, Texas (Qin); and Baylor Research Institute, Dallas, Texas (Hawkins). Dr. Beal is now affiliated with the University of Florida Health Shands, Gainesville, Florida.
authors.forename: Daniel
authors.initials: D
authors.lastname: Nguyen
authors.affiliation: Department of Pathology and Laboratory Medicine (Beal, Thomas, Dekmezian, Benavides) and the Department of Pharmacy (Nguyen), Baylor University Medical Center at Dallas; med fusion Laboratory, Lewisville, Texas (Beal, Thomas, Dhiman, Dekmezian, Benavides); the Department of Quantitative Science, Baylor Health Care System, Dallas, Texas (Qin); and Baylor Research Institute, Dallas, Texas (Hawkins). Dr. Beal is now affiliated with the University of Florida Health Shands, Gainesville, Florida.
authors.forename: Huanying
authors.initials: H
authors.lastname: Qin
authors.affiliation: Department of Pathology and Laboratory Medicine (Beal, Thomas, Dekmezian, Benavides) and the Department of Pharmacy (Nguyen), Baylor University Medical Center at Dallas; med fusion Laboratory, Lewisville, Texas (Beal, Thomas, Dhiman, Dekmezian, Benavides); the Department of Quantitative Science, Baylor Health Care System, Dallas, Texas (Qin); and Baylor Research Institute, Dallas, Texas (Hawkins). Dr. Beal is now affiliated with the University of Florida Health Shands, Gainesville, Florida.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Hawkins
authors.affiliation: Department of Pathology and Laboratory Medicine (Beal, Thomas, Dekmezian, Benavides) and the Department of Pharmacy (Nguyen), Baylor University Medical Center at Dallas; med fusion Laboratory, Lewisville, Texas (Beal, Thomas, Dhiman, Dekmezian, Benavides); the Department of Quantitative Science, Baylor Health Care System, Dallas, Texas (Qin); and Baylor Research Institute, Dallas, Texas (Hawkins). Dr. Beal is now affiliated with the University of Florida Health Shands, Gainesville, Florida.
authors.forename: Mhair
authors.initials: M
authors.lastname: Dekmezian
authors.affiliation: Department of Pathology and Laboratory Medicine (Beal, Thomas, Dekmezian, Benavides) and the Department of Pharmacy (Nguyen), Baylor University Medical Center at Dallas; med fusion Laboratory, Lewisville, Texas (Beal, Thomas, Dhiman, Dekmezian, Benavides); the Department of Quantitative Science, Baylor Health Care System, Dallas, Texas (Qin); and Baylor Research Institute, Dallas, Texas (Hawkins). Dr. Beal is now affiliated with the University of Florida Health Shands, Gainesville, Florida.
authors.forename: Raul
authors.initials: R
authors.lastname: Benavides
references.citation: Chest. 2000 Jul;118(1):146-55
references.pmid: 10893372
references.citation: Clin Infect Dis. 2003 Jun 1;36(11):1418-23
references.pmid: 12766837
references.citation: Antimicrob Agents Chemother. 2008 Oct;52(10):3558-63
references.pmid: 18663022
references.citation: Infect Control Hosp Epidemiol. 2010 Oct;31(10):1043-8
references.pmid: 20731594
references.citation: Clin Infect Dis. 2010 Nov 1;51(9):1074-80
references.pmid: 20879856
references.citation: J Clin Microbiol. 2012 Jan;50(1):127-33
references.pmid: 22075595
references.citation: Diagn Microbiol Infect Dis. 2012 Dec;74(4):349-55
references.pmid: 22999332
references.citation: Arch Pathol Lab Med. 2013 Sep;137(9):1247-54
references.pmid: 23216247
references.citation: J Clin Microbiol. 2013 Dec;51(12):4008-11
references.pmid: 24068006
references.citation: J Clin Microbiol. 2013 Dec;51(12):4130-6
references.pmid: 24088863
references.citation: J Glob Antimicrob Resist. 2013 Dec;1(4):207-212
references.pmid: 27873614