title: Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time.
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.
authors.affiliation: 1Houston Methodist Hospital System,Houston,Texas.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Lockwood
authors.affiliation: 1Houston Methodist Hospital System,Houston,Texas.
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Perez
authors.affiliation: 1Houston Methodist Hospital System,Houston,Texas.
authors.forename: William L
authors.initials: WL
authors.lastname: Musick
authors.affiliation: 1Houston Methodist Hospital System,Houston,Texas.
authors.forename: Judy O
authors.initials: JO
authors.lastname: Ikwuagwu
authors.affiliation: 1Houston Methodist Hospital System,Houston,Texas.
authors.forename: Engie
authors.initials: E
authors.lastname: Attia
authors.affiliation: 1Houston Methodist Hospital System,Houston,Texas.
authors.forename: Oyejoke O
authors.initials: OO
authors.lastname: Fasoranti
authors.affiliation: 1Houston Methodist Hospital System,Houston,Texas.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Cernoch
authors.affiliation: 1Houston Methodist Hospital System,Houston,Texas.
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Olsen
authors.affiliation: 1Houston Methodist Hospital System,Houston,Texas.
authors.forename: James M
authors.initials: JM
authors.lastname: Musser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy; D001431:Bacteriological Techniques; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D013781:Texas
chemical_list: D000900:Anti-Bacterial Agents