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Automated Alerts Coupled with Antimicrobial Stewardship Intervention Lead to Decreases in Length of Stay in Patients with Gram-Negative Bacteremia

Published online by Cambridge University Press:  10 May 2016

Jason M. Pogue ,
Ryan P. Mynatt ,
Dror Marchaim ,
Jing J. Zhao ,
Viktorija O. Barr ,
Judy Moshos ,
Bharath Sunkara ,
Teena Chopra ,
Sowmya Chidurala  and
Keith S. Kaye
Jason M. Pogue*
Affiliation:
Department of Pharmacy, Sinai-Grace Hospital, Detroit Medical Center, Detroit, Michigan Wayne State University School of Medicine, Detroit, Michigan
Ryan P. Mynatt
Affiliation:
Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan
Dror Marchaim
Affiliation:
Wayne State University School of Medicine, Detroit, Michigan
Jing J. Zhao
Affiliation:
Department of Pharmacy, Harper University Hospital, Detroit Medical Center, Detroit, Michigan
Viktorija O. Barr
Affiliation:
Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan
Judy Moshos
Affiliation:
Sinai-Grace Hospital, Detroit Medical Center, Detroit, Michigan
Bharath Sunkara
Affiliation:
Wayne State University School of Medicine, Detroit, Michigan
Teena Chopra
Affiliation:
Wayne State University School of Medicine, Detroit, Michigan Department of Internal Medicine, Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan
Sowmya Chidurala
Affiliation:
Wayne State University School of Medicine, Detroit, Michigan
Keith S. Kaye
Affiliation:
Wayne State University School of Medicine, Detroit, Michigan Department of Internal Medicine, Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan
*
Sinai-Grace Hospital, Detroit Medical Center, 6071 West Outer Drive, Detroit, MI 48235 ([email protected])
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Abstract

Objective.

To assess the impact of active alerting of positive blood culture data coupled with stewardship intervention on time to appropriate therapy, length of stay, and mortality in patients with gram-negative bacteremia.

Design.

Quasi-experimental retrospective cohort study in patients with gram-negative bacteremia at the Detroit Medical Center from 2009 to 2011.

Setting.

Three hospitals (1 community, 2 academic) with active antimicrobial stewardship programs within the Detroit Medical Center.

Patients.

All patients with monomicrobial gram-negative bacteremia during the study period.

Intervention.

Active alerting of positive blood culture data coupled with stewardship intervention (2010-2011) compared with patients who received no formalized stewardship intervention (2009).

Results.

Active alerting and intervention led to a decreased time to appropriate therapy (8 [interquartile range (IQR), 2-24] vs 14 [IQR, 2-35] hours; P = .014) in patients with gram-negative bacteremia. After controlling for differences between groups, being in the intervention arm was associated with an independent reduction in length of stay (odds ratio [OR], 0.73 [95% confidence interval (CI), 0.62-0.86]), correlating to a median attributable decrease in length of stay of 2.2 days. Additionally, multivariate modeling of patients who were not on appropriate antimicrobial therapy at the time of initial culture positivity showed that patients in the intervention group had a significant reduction in both length of stay (OR, 0.76 [95% CI, 0.66-0.86]) and infection-related mortality (OR, 0.24 [95% CI, 0.08-0.76]).

Conclusions.

Active alerting coupled with stewardship intervention in patients with gram-negative bacteremia positively impacted time to appropriate therapy, length of stay, and mortality and should be a target of antimicrobial stewardship programs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 2 , February 2014 , pp. 132 - 138
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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