title: Effect of Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) Alone versus MALDI-TOF MS Combined with Real-Time Antimicrobial Stewardship Interventions on Time to Optimal Antimicrobial Therapy in Patients with Positive Blood Cultures.
abstract: Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) decreases the time to organism identification and improves clinical and financial outcomes. The purpose of this study was to evaluate the impact of MALDI-TOF MS alone versus MALDI-TOF MS combined with real-time, pharmacist-driven, antimicrobial stewardship (AMS) intervention on patient outcomes. This single-center, pre-post, quasiexperimental study evaluated hospitalized patients with positive blood cultures identified via MALDI-TOF MS combined with prospective AMS intervention compared to a control cohort with MALDI-TOF MS identification without AMS intervention. AMS intervention included: real-time MALDI-TOF MS pharmacist notification and prospective AMS provider feedback. The primary outcome was the time to optimal therapy (TTOT). A total of 252 blood cultures, 126 in each group, were included in the final analysis. MALDI-TOF MS plus AMS intervention significantly reduced the overall TTOT (75.17 versus 43.06 h;P< 0.001), the Gram-positive contaminant TTOT (48.21 versus 11.75 h;P< 0.001), the Gram-negative infection (GNI) TTOT (71.83 versus 35.98 h;P< 0.001), and the overall hospital length of stay (LOS; 15.03 versus 9.02 days;P= 0.021). The TTOT for Gram-positive infection (GPI) was improved (64.04 versus 41.61 h;P= 0.082). For GPI, the hospital LOS (14.64 versus 10.31 days;P= 0.002) and length of antimicrobial therapy 24.30 versus 18.97 days;P= 0.018) were reduced. For GNI, the time to microbiologic clearance (51.13 versus 34.51 h;P< 0.001), the hospital LOS (15.40 versus 7.90 days;P= 0.027), and the intensive care unit LOS (5.55 versus 1.19 days;P= 0.035) were reduced. To achieve optimal outcomes, rapid identification with MALDI-TOF MS combined with real-time AMS intervention is more impactful than MALDI-TOF MS alone.
authors.affiliation: Department of Pharmacy, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA maya.beganovic@gmail.com sarah.wieczorkiewicz@advocatehealth.com.
authors.forename: Maya
authors.initials: M
authors.lastname: Beganovic
authors.affiliation: ACL Laboratories, Milwaukee, Wisconsin, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Costello
authors.affiliation: Department of Pharmacy, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA maya.beganovic@gmail.com sarah.wieczorkiewicz@advocatehealth.com.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Wieczorkiewicz
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D000071997:Blood Culture; D002648:Child; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: MALDI-TOF MS; antimicrobial stewardship; rapid molecular diagnostics