Protocol decreases broad-spectrum antibiotic use in patients with sepsis
PHILADEPHIA — A new protocol implemented to treat patients with sepsis reduced the time that they were on broad-spectrum antibiotics, decreased their length of stay and saved a hospital in Pennsylvania over $300,000 in 4 months, according to findings presented at the conference for the Association for Professionals in Infection Control Epidemiology.
The interdisciplinary approach involved using a rapid blood culture test to identify the bacteria causing a patient’s infection and immediately consulting with a pharmacist, who made recommendations on how to manage or readjust previously prescribed antibiotic regimens.
“The key thing to remember about our institution — which is why I think this overall was a success — is that the laboratory and pharmacy are staffed 24/7,” David Ezdon, PharmD, an infectious diseases clinical pharmacist at Einstein Medical Center Montgomery, outside of Philadelphia, said during his presentation.
Ezdon and colleagues noted that broad-spectrum antibiotics prescribed for patients with sepsis often are not de-escalated in a timely manner. Their study assessed the integration of comprehensive blood culture identification testing into an existing antimicrobial stewardship program at Einstein Medical Center Montgomery in an effort to reduce broad-spectrum antibiotic use.
The antimicrobial stewardship team worked with the microbiology lab to implement the rapid blood culture identification PCR testing, which was used along with a gram stain when blood cultures were positive, Ezdon and colleagues explained. Results were relayed to the nurse and a pharmacist, who used a preapproved algorithm to make their treatment recommendations.
“From the pharmacy perspective, in conjunction with our infectious disease provider and the physicians on our staff, we developed an algorithm to relay the recommendations to the hospitalist or the physician,” Ezdon said. “One of things that we were trying to do was to not to have to call me 24/7, so I’m not getting the results of MRSA in the blood at 3 a.m. Instead, we can crowdsource this to the entire pharmacy staff with some pretty robust recommendations.”
Ezdon and colleagues retrospectively reviewed data between Jan. 1, 2017, and Aug. 31, 2018, assessing time to antibiotic de-escalation, broad-spectrum antibiotic days, length of stay and cost avoidance for 4 months before and after the intervention was implemented.
According to the study, 99 patients were assessed preintervention and 103 patients were assessed postintervention.
Ezdon and colleagues found that there was a 25-hour reduction in time to antibiotic de-escalation after implementation, that a total of 70 antibiotic days were avoided and that length of stay was reduced by 1.45 days per patient. The hospital saved $322,508 over 4 months, based on the decreased length of stay.
Ezdon and colleagues said the findings suggest that combining comprehensive blood culture testing with antibiotic stewardship leads to a rapid adjustment of antibiotics, decrease in broad-spectrum antibiotic use and decreased length of stay. – by Marley Ghizzone
Ezdon D, et al. Integrating rapid diagnostics and antimicrobial stewardship for blood cultures improves antibiotic use in a community hospital. Presented at: APIC 2019; June 12-14, 2019; Philadelphia.
Disclosures: The authors report no relevant financial disclosures.