title: Clinical Impact and Provider Acceptability of Real-Time Antimicrobial Stewardship Decision Support for Rapid Diagnostics in Children With Positive Blood Culture Results.
abstract: BACKGROUND
  Rapid diagnostic technologies for infectious diseases have the potential to improve clinical outcomes, but guideline-recommended antimicrobial stewardship (AS) strategies are not currently optimized for rapid intervention. We evaluated the clinical impact and provider acceptability of implementing real-time AS decision support for children with positive blood culture results according to the FilmArray blood culture identification panel (BCID [BioFire Diagnostics]) at Children's Hospital Colorado.
  
  
  METHODS
  A pre-post quasi-experimental design was used to compare the outcomes of 100 postintervention children with positive blood culture results matched with 200 preintervention control children. Causative organisms in the preintervention group were identified using conventional microbiologic techniques and communicated to providers by a microbiology technologist. Postintervention organisms were identified by the BCID and communicated by an AS provider in real time with interpretation and antimicrobial recommendations. The primary outcome was time to optimal antimicrobial therapy (time from blood culture collection to start of predetermined pathogen-specific regimen or antimicrobial discontinuation for contaminants) compared by a log-rank test and Kaplan-Meier analysis. Provider acceptability of the intervention was assessed via E-mailed surveys.
  
  
  RESULTS
  The median time to optimal therapy decreased from 60.2 hours before intervention to 26.7 hours after intervention (P = .001). Among children with blood cultures that contained true pathogens, the time to effective antimicrobial therapy decreased from 6.9 to 3.4 hours (P = .03). Unnecessary antibiotic initiation for children with a culture that contained organisms considered to be contaminants decreased from 76% to 26% (P < .001). Providers reported a change in management as a result of BCID results in 73% of the cases and a mean overall satisfaction rating of 4.8 on a 5-point Likert scale.
  
  
  CONCLUSIONS
  Real-time AS decision support for rapid diagnostics is associated with improved antimicrobial use and high satisfaction ratings by providers.
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases.|Department of Pediatrics, Section of Hospital Medicine, University of Colorado/Children's Hospital.
authors.forename: Kevin
authors.initials: K
authors.lastname: Messacar
authors.affiliation: Pharmacy.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Hurst
authors.affiliation: Pharmacy.
authors.forename: Jason
authors.initials: J
authors.lastname: Child
authors.affiliation: Department of Biostatistics and Informatics, University of Colorado School of Public Health.
authors.forename: Kristen
authors.initials: K
authors.lastname: Campbell
authors.affiliation: Department of Pediatrics, University of Colorado.
authors.forename: Claire
authors.initials: C
authors.lastname: Palmer
authors.affiliation: Department of Pathology and Laboratory Medicine.
authors.forename: Stacey
authors.initials: S
authors.lastname: Hamilton
authors.affiliation: Department of Pathology and Laboratory Medicine.
authors.forename: Elaine
authors.initials: E
authors.lastname: Dowell
authors.affiliation: Department of Pathology and Laboratory Medicine.
authors.forename: Christine C
authors.initials: CC
authors.lastname: Robinson
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Parker
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases.|Department of Epidemiology, Children's Hospital Colorado, Aurora.
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Dominguez
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000073602:Antimicrobial Stewardship; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D065187:Controlled Before-After Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents
keywords: antimicrobial stewardship; bloodstream infections; outcomes; rapid diagnostics