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Cited by 6Bacterial Identification and Susceptibility TestingAntibiotic Use and ResistanceNeutropenia and Cancer Infections

Real Life Clinical Impact of Antimicrobial Stewardship Actions on the Blood Culture Workflow from a Microbiology Laboratory

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López-Pintor, Jose Maria, Sánchez-López, Javier, Navarro-San Francisco, Carolina, Sánchez-Díaz, Ana Maria, Loza, Elena, Cantón, Rafael·2021·Antibiotics
DOI 10.3390/antibiotics10121511PMC PMC8698396
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Abstract

Background: Accelerating the diagnosis of bacteremia is one of the biggest challenges in clinical microbiology departments. The fast establishment of a correct treatment is determinant on bacteremic patients’ outcomes. Our objective was to evaluate the impact of antimicrobial therapy and clinical outcomes of a rapid blood culture workflow protocol in positive blood cultures with Gram-negative bacilli (GNB). Methods: A quasi-experimental before–after study was performed with two groups: (i) control group (conventional work-protocol) and (ii) intervention group (rapid workflow-protocol: rapid identification by Matrix-Assisted Laser Desorption/Ionization-Time-Of-Flight (MALDI-TOF) and antimicrobial susceptibility testing (AST) from bacterial pellet without overnight incubation). Patients were divided into different categories according to the type of intervention over treatment. Outcomes were compared between both groups. Results: A total of 313 patients with GNB-bacteremia were included: 125 patients in the control group and 188 in the intervention. The time from positive blood culture to intervention on antibiotic treatment decreased from 2.0 days in the control group to 1.0 in the intervention group (p < 0.001). On the maintenance of correct empirical treatment, the control group reported 2.0 median days until the clinical decision, while in the intervention group was 1.0 (p < 0.001). In the case of treatment de-escalation, a significant difference between both groups (4.0 vs. 2.0, p < 0.001) was found. A decreasing trend on the change from inappropriate treatments to appropriate ones was observed: 3.5 vs. 1.5; p = 0.12. No significant differences were found between both groups on 7-days mortality or on readmissions in the first 30-days. Conclusions: Routine implementation of a rapid workflow protocol anticipates the report of antimicrobial susceptibility testing results in patients with GNB-bacteremia, decreasing the time to effective and optimal antibiotic therapy.

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Authors
López-Pintor, J. M., Sánchez-López, J., Navarro-San Francisco, C., Sánchez-Díaz, A. M., Loza, E., & Cantón, R.
Affiliations
  • Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
  • Instituto de Salud Carlos III (ES)
ORCID
Venue
Antibiotics
Publisher
MDPI AG
Published
2021-12-09
Volume
10
Issue
12
Pages
1511
ISSN
2079-6382 (ISSN-L)
DOI
10.3390/antibiotics10121511
PMC
PMC8698396
OpenAlex
W4200611071
Cited by
6
References
0
Citations by year
2025: 2 · 2024: 3 · 2022: 1
FWCI
0.70
Type
journal article
Language
en
Open access
Licence
Locations
  • Antibiotics (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
Keywords
antimicrobial stewardship, antimicrobial susceptibility testing, empirical antibiotic therapy, treatment de-escalation, 7-day mortality, hospital readmission

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