Document Detail


Impact of Rapid Organism Identification via Matrix-Assisted Laser Desorption Ionization Time-of-Flight Combined with Antimicrobial Stewardship Team Intervention in Adult Patients with Bacteremia and Candidemia.
MedLine Citation:
PMID:  23899684     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background. Integration of rapid diagnostic testing via matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) with antimicrobial stewardship team (AST) intervention has the potential for early organism identification, customization of antibiotic therapy and improvement in patient outcomes. The objective of this study was to assess the impact of this combined approach on clinical and antimicrobial therapy-related outcomes in patients with bloodstream infections. Methods. A pre-post quasi-experimental study was conducted to analyze the impact of MALDI-TOF with AST intervention in patients with bloodstream infections. The AST provided evidence-based antibiotic recommendations after receiving real-time notification following blood culture Gram stain, organism identification, and antimicrobial susceptibilities. Outcomes were compared to a historic control group. Results. A total of 501 patients with bacteremia or candidemia were included in the final analysis: 245 patients in the intervention group and 256 patients in the pre-intervention group. MALDI-TOF with AST intervention decreased time to organism identification (84.0 vs 55.9 hours, P<0.001), and improved time to effective antibiotic therapy (30.1 vs 20.4 hours, P=0.021) and optimal antibiotic therapy (90.3 vs 47.3 hours, P<0.001). Mortality (20.3 vs 14.5%), length of intensive care unit stay (14.9 vs 8.3 days), and recurrent bacteremia (5.9 vs 2.0%) were lower in the intervention group on univariate analysis, and acceptance of an AST intervention was associated with a trend toward reduced mortality on multivariable analysis (OR 0.55, P=0.075). Conclusion. MALDI-TOF with AST intervention decreased time organism identification, and time to effective and optimal antibiotic therapy.
Authors:
Angela M Huang; Duane Newton; Anjly Kunapuli; Tejal N Gandhi; Laraine L Washer; Jacqueline Isip; Curtis D Collins; Jerod L Nagel
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-7-29
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  -     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-7-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Departments of Pharmacy Services and Clinical Sciences, University of Michigan Health System and College of Pharmacy.
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