Bookstaver PB, et al. – Authors undertook this quasi–experimental cohort study to evaluate the combined impact of an antimicrobial stewardship program (ASP)/rapid diagnostic tests (RDTs) bundle on the appropriateness of empirical antimicrobial therapy (EAT) and time to de–escalation of broad–spectrum antimicrobial agents (BSAA) in Gram–negative bloodstream infections (GNBSI). The implementation of an ASP/RDT bundle in a multihospital health care system seemed associated with improved appropriateness of EAT for GNBSI and decreased utilization of BSAA through early de–escalation.

Methods

• The ASP/RDT bundle seemed consisting of system-wide GNBSI treatment guidelines, prospective stewardship monitoring, and sequential introduction of two RDTs, matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) and the FilmArray blood culture identification (BCID) panel.
• Period from January 2010 to December 2013 was analyzed as the preintervention period , and the postintervention period analyzed was from January 2014 to June 2015.
• Authors conducted the postintervention period in two phases; phase 1 followed the introduction of MALDI-TOF MS, and phase 2 followed the introduction of the FilmArray BCID panel.

Results

• A marked improvement in appropriateness of EAT (95% versus 91%; P = 0.02) was evident with implementation of the interventions.
• There appeared marked reductions in median time to de-escalation from combination antimicrobial therapy (2.8 versus 1.5 days), antipseudomonal beta-lactams (4.0 versus 2.5 days), and carbapenems (4.0 versus 2.5 days) in the postintervention compared to the preintervention period (P < 0.001 for all).
• Further augmentation in reduction in median time to de-escalation from combination therapy (1.0 versus 2.0 days; P = 0.03) and antipseudomonal beta-lactams (2.2 versus 2.7 days; P = 0.04) was observed during phase 2 compared to phase 1 of the postintervention period.