Antimicrobial Stewardship Pharmacist Interventions for Coagulase-Negative Staphylococci Positive Blood Cultures Using Rapid Polymerase Chain Reaction

2012 ◽  
Vol 46 (11) ◽  
pp. 1484-1490 ◽  
Author(s):  
Jordan R Wong ◽  
Karri A Bauer ◽  
Julie E Mangino ◽  
Debra A Goff
Keyword(s):  
Polymerase Chain Reaction ◽  
Blood Culture ◽  
Blood Cultures ◽  
Hospital Length Of Stay ◽  
Chain Reaction ◽  
Coagulase Negative Staphylococci ◽  
Pharmacist Interventions ◽  
Rapid Polymerase Chain Reaction ◽  
Polymerase Chain ◽  
The Impact

BACKGROUND: No studies exist regarding the value of pharmacist interventions using rapid identification of coagulase-negative staphylococci (CoNS) by rapid polymerase chain reaction (rPCR) from blood cultures. OBJECTIVE: To evaluate the impact of interventions by infectious diseases pharmacists (ID PharmDs) on blood cultures positive for CoNS using rPCR and assess the duration of antistaphylococcal antibiotic therapy, hospital length of stay (LOS), and related costs. METHODS: A quasi-experimental, pre- and postintervention study of patients with positive blood cultures for CoNS, identified using rPCR, was conducted. Patients were included if there was a blood culture for CoNS from January 1, 2011, to March 31, 2011 (preintervention), or October 1, 2011, to January 18, 2012 (post-intervention). Exclusion criteria included age younger than 18 years or 89 years or older, neutropenia, incomplete records, and duplicate or mixed blood cultures. The setting was a 1200-bed academic medical center. The ID PharmD intervened on blood cultures identified in the postintervention group as CoNS after notification from the microbiology laboratory. The pre- and postintervention groups were compared to analyze the effect of the intervention. The primary outcome was time to discontinuation of antistaphylococcal antibiotics by the pharmacist intervention in patients with a positive blood culture for CoNS that was determined to be a contaminant. RESULTS: We analyzed 53 patients (31 preintervention, 22 postintervention) with CoNS blood culture contaminants. In the postintervention group, antistaphylococcal antibiotics were discontinued 32.0 hours sooner from time of rPCR result (median 57.7 vs 25.7 hours; p = 0.005), total antibiotic exposure decreased 43.5 hours (97.6 vs 54.1 hours; p = 0.011), infection-related LOS decreased 4.5 days (10 vs 5.5 days; p = 0.018), and infection-related costs decreased $8338 ($28,973 vs $20,635; p = 0.144). The pharmacist initiated vancomycin in 7 (21.9%) patients with CoNS bloodstream infections. CONCLUSIONS: Timely interventions by ID PharmDs using rPCR are required to impact the outcomes of patients with positive blood cultures for CoNS.

scholarly journals 1400. Impact of a Multiplex Polymerase Chain Reaction Meningitis/Encephalitis Panel and Antimicrobial Stewardship Bundle on Antimicrobial Use in Patients with Suspected Meningitis or Encephalitis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S509-S509
Author(s):  
Katelyn Woodbury ◽  
Megan Seddon ◽  
Andre McMahon ◽  
Jamie Kisgen
Keyword(s):  
Polymerase Chain Reaction ◽  
Median Time ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Total Duration ◽  
Hospital Length Of Stay ◽  
Chain Reaction ◽  
Rapid Polymerase Chain Reaction ◽  
Significant Difference ◽  
Polymerase Chain

Abstract Background Optimal treatment of meningitis relies on prompt diagnostic evaluation and initiation of appropriate antimicrobials. The meningitis/encephalitis panel (MEP) is a multiplex rapid polymerase chain reaction, with the ability to detect 14 community-acquired pathogens in 1 hour. The purpose of this study was to evaluate impact of the MEP on de-escalation of antimicrobials in adult inpatients with suspected meningitis at a large community teaching hospital. Methods This single-center retrospective quasi-experimental pre/post study included adults admitted for ≥48 hours and initiated on antimicrobial therapy for suspected meningitis. Those with healthcare-associated meningitis, immunosuppression, initiation of antimicrobials >8 hours prior to lumbar puncture (LP), and use of antimicrobials for another indication were excluded. The pre-group included patients admitted prior to MEP introduction. The post-group included patients with the MEP performed. An antimicrobial stewardship bundle consisting of a meningitis order set, provider education, and use of a real-time meningitis alert in clinical decision support software was also implemented in the post-group. The primary outcome was percentage of patients experiencing antimicrobial de-escalation ≤48 hours after LP. Secondary outcomes included time to de-escalation, total duration of antimicrobial therapy (DOT), and hospital length of stay (LOS). Results A total of 45 patients were included in the study (23 pre-group and 22 post-group). Baseline characteristics were similar between groups. The percentage of patients experiencing de-escalation of antimicrobials ≤ 48 hours after LP increased by 44% in the post-group (82% vs. 38%, P = 0.005). The overall median time to de-escalation of antimicrobials decreased by 35 hours [11.1 (IQR 5.6, 17.6) vs. 46.1 (IQR 18.4, 66.5); P = 0.002] and the median time to de-escalation after LP decreased by 38 hours [13.6 (IQR 8.3, 20.3) vs. 51.6 (IQR 44.2, 69.8); P < 0.001]. No statistically significant difference in hospital LOS or total DOT was seen. Conclusion Implementation of the MEP and antimicrobial stewardship bundle increased the percentage of patients de-escalated in 48 hours and decreased the time to de-escalation. However, this did not impact the total DOT or hospital LOS. Disclosures All authors: No reported disclosures.

scholarly journals Validation of polymerase chain reaction in experimental sepsis diagnosis beyond blood culture

Critical Care ◽  
2008 ◽  
Vol 12 (Suppl 5) ◽  
pp. P47
Author(s):  
Marcello Ruiz-Silva ◽  
Derci Sa-Filho ◽  
Marcos Caseiro ◽  
Ivan Koh
Keyword(s):  
Polymerase Chain Reaction ◽  
Blood Culture ◽  
Experimental Sepsis ◽  
Chain Reaction ◽  
Sepsis Diagnosis ◽  
Polymerase Chain

Diagnostic Value of Multiplex Polymerase Chain Reaction in Detection of Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia from Sepsis in Pediatrics

2021 ◽  
Vol 15 ◽  
Author(s):  
Sara Galeb ◽  
Maysaa El Sayed Zaki ◽  
Raghdaa Shrief ◽  
Rasha Hassan ◽  
Mohamed Anies
Keyword(s):  
Polymerase Chain Reaction ◽  
Pseudomonas Aeruginosa ◽  
Acinetobacter Baumannii ◽  
Multiplex Pcr ◽  
Stenotrophomonas Maltophilia ◽  
Multiplex Polymerase Chain Reaction ◽  
Diagnostic Value ◽  
Blood Cultures ◽  
Chain Reaction ◽  
Polymerase Chain

Background: Proper identification of the causative organism in pediatric sepsis is crucial for early diagnosis and prevention of septic shock and organ failure. Objectives: The present study aimed to evaluate the multiplex Polymerase Chain Reaction (PCR) to detect Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia from positive blood cultures for these pathogens isolated from children, with hospital-acquired sepsis compared to the conventional biochemical reactions for identification of these organisms. Methods: This study was a cross-sectional study performed on 100 isolates from pediatric blood cultures, including Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. The study also included 100 isolates of Escherichia coli as a negative control. All isolates were identified by API 20NE and the multiplex PCR, with primers specific to the 3 tested bacteria. Results: Multiplex PCR was positive in 96% of isolates, and 4 isolates had negative results. False positive results were reported with three E. coli strains. Multiplex PCR identified all the isolates of Acinetobacter baumannii, 29 isolates of Pseudomonas aeruginosa, and 27 isolates of Stenotrophomonas maltophilia. Compared to the biochemical identification, the diagnostic value of the multiplex PCR revealed 96.04% sensitivity, 96.9% specificity, 97.00%, positive predictive value, 96.00% negative predictive value, and 96.50% accuracy. Conclusion: The present study highlights the diagnostic value of multiplex PCR to identify Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia from positive blood cultures. Multiplex PCR was sensitive, specific, and accurate. The accuracy differs according to the organisms, with 100% accuracy for Acinetobacter baumannii.

scholarly journals Polymerase Chain Reaction and blood culture for diagnosis of canine sepsis

2018 ◽  
Vol 48 (6) ◽  
Author(s):  
Marcelo Marques da Silveira ◽  
Stéfhano Luis Cândido ◽  
Karin Rinaldi dos Santos ◽  
Maerle Oliveira Maia ◽  
Roberto Lopes de Souza ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Blood Culture ◽  
Diagnostic Value ◽  
Turnaround Time ◽  
Diagnostic Techniques ◽  
Pcr Analysis ◽  
Chain Reaction ◽  
Suspected Sepsis ◽  
Fungal Dna ◽  
Polymerase Chain

ABSTRACT: Sepsis is characterized by the presence of organ dysfunction secondary to the dysregulated systemic inflammatory response associated with an infection, and has high mortality rates. Traditional diagnostic techniques based on non-microbiological isolation are time-consuming and may delay treatment. Thus, this study aimed to compare bacterial and fungal broad-range polymerase chain reaction (PCR) and blood culture for diagnosis of sepsis in dogs. Blood samples from 88 dogs with suspected sepsis were analyzed by blood culture, and PCR to detect bacterial and fungal DNA. On blood culture, 20 (22.7%) samples tested positive for bacterial isolates; however, none tested positive for fungi. Through PCR analysis, bacterial DNA was detected in 46 (52.3%) animals, whereas fungal DNA was present in one (1.1%) sample. Our results showed that PCR-based testing has important diagnostic value for canine blood infections because it has a shorter turnaround time and higher sensitivity than traditional blood culture.

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