Category: Antimicrobial Stewardship: Diagnostics/Diagnostic Stewardship

Poster Session: Antimicrobial Stewardship: Diagnostics/Diagnostic Stewardship

110 - Impact of Diagnostic and Antimicrobial Stewardship on Time-to-Appropriate Therapy and Clinical Outcomes in Multi-Drug Resistant Pseudomonas Infections

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Presenting Author(s)

Katie A. McCrink

PGY2 Infectious Diseases Pharmacy Resident
Jackson Health System
Madison, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

KD

Kailynn Deronde

Clinical Hospital Pharmacist - Pediatric/Adult Infectious Disease and Antimicrobial Stewardship
Jackson Memorial Hospital
Miami, Florida
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AJ

Adriana Jimenez

Infection Prevention Specialist
Jackson Health System
Miami, Florida
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GR

Gemma Rosello

Infection Control Coordinator
Jackson Memorial Hospital
Miami, Florida
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Yoichiro Natori

Associate Professor
University of Miami, Miami Transplant Institute, Jackson Health System
Miami, Florida
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Kimberly C. Claeys

Associate Professor
University of Maryland Baltimore
Baltimore, MD
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
OM

Octavio Martinez

Director, Clinical Microbiology Laboratory
Jackson Health System/University of Miami
Miami, FL
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BD

Biagio De Pascale

Microbiology Supervisor
Jackson Health System
Miami, Florida
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AP

Armando Perez-Cardona

BS
Jackson Memorial Hospital
Miami, Florida
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Lilian M. Abbo

Professor of Infectious Diseases; Associate Chief Medical Officer in Infectious Diseases
University of Miami Miller School of Medicine, Miami Transplant Institute and Jackson Health System
Miami, FL
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AV

Ana Vega

Clinical Hospital Pharmacist- Infectious Diseases
Jackson Memorial Hospital
Miami, Florida
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Timely effective therapy in multi-drug resistant (MDR) Pseudomonas (PsA) infections has a direct impact on patient survival. We aimed to determine the impact of diagnostic and antimicrobial stewardship (AMS) on time-to-appropriate therapy (TAP) and clinical outcomes of patients with MDR PsA infections utilizing novel beta-lactam/beta-lactamase inhibitors (BL/BLIs).

Methods: Retrospective cohort study of adult patients with MDR PsA infections at a 1,500-bed University-affiliated public hospital in Miami, Florida who received ≥72 hours of ceftazidime-avibactam (C/A) or ceftolozane-tazobactam (C/T). During the pre-intervention period (12/2017-12/2018), additional susceptibilities for C/A and C/T were performed upon providers’ request. In the post intervention period (01/2019 – 12/2019), we implemented automatic reflex algorithms (Figure 1) for faster identification and susceptibilities for MDR PsA, including carbapenemase producers. Results were communicated in real-time to the AMS team.Figure 1. Reflex Testing Algorithm for MDR Pseudomonas Isolates from Any Source

Results: Seventy-six patients were included; median age was 56 years (IQR 37.5-67.0), 40 (52.6%) were in an intensive care unit at time of culture collection; median APACHE II score was 20 (IQR 15.0 – 26.0). Three isolates were carbapenemase producers (VIM = 2; KPC = 1). The most common infections were pneumonia (56.6%) and bacteremia (18.4%). We found a significant decrease in median TAP (120.1 [IQR 82.5–164.6] vs 75.9 [IQR 51.3–101.7] hours, p = 0.003). Median time from culture collection to final susceptibility results was shorter in the post-intervention group (122.2 vs 90.5 hours; p < 0.001). Median length-of-stay after culture collection was numerically lower in the post-intervention group (26.0 [11.6-59.4] vs 19.7 [12.9-37.8] days; p = 0.33). Controlling for ICU admission, our intervention was not associated with decreased 30-day inpatient mortality (OR = 1.62, 95% CI 0.45–5.79).

Conclusion: Our study identified an improvement in TAP in MDR PsA infections with implementation of diagnostic and AMS initiatives. In an adequately powered study, our intervention could potentially impact patient survival through timely initiation of effective therapy with novel BL/BLIs.