Cumulative Effect of an Antimicrobial Stewardship and Rapid Diagnostic Testing Bundle on Early Streamlining of Antimicrobial Therapy in Gram-Negative Bloodstream Infections.

摘要: ABSTRACT The use of rapid diagnostic tests (RDTs) enhances antimicrobial stewardship program (ASP) interventions in optimization therapy. This quasi-experimental cohort study evaluated the combined impact an ASP/RDT bundle on appropriateness empirical therapy (EAT) and time to de-escalation broad-spectrum agents (BSAA) Gram-negative bloodstream infections (GNBSI). consisted system-wide GNBSI treatment guidelines, prospective monitoring, sequential introduction two RDTs, matrix-assisted laser desorption ionization–time flight mass spectrometry (MALDI-TOF MS) FilmArray blood culture identification (BCID) panel. preintervention period was January 2010 through December 2013, postintervention followed from 2014 June 2015. conducted phases; phase 1 MALDI-TOF MS, 2 BCID resulted significantly improved EAT (95% versus 91%; P = 0.02). Significant reductions median combination (2.8 1.5 days), antipseudomonal beta-lactams (4.0 2.5 carbapenems days) were observed compared ( 0.03) (2.2 2.7 days; 0.04) further augmented during period. Implementation RDT intervention a multihospital health care system is associated with for decreased utilization BSAA early de-escalation.