The impact of rapid diagnostic testing, surveillance software, and clinical pharmacist staffing at a large community hospital in the management of Gram-negative bloodstream infections

Rapid diagnostic testing (RDT) combined with an antimicrobial stewardship program (ASP) has shown improved outcomes in bloodstream infections (BSIs). We assessed the impact of RUT, surveillance software, and ASP pharmacist staffing on time to optimal therapy (TOT) in Gram-negative BSIs. Adults with Gram-negative BSIs were included in this retrospective evaluation across 2 study periods. The preimplementation group (n = 121) had longer TOT than the postimplementation group (n = 120) (59.6 +/- 36.2 h versus 29.0 +/- 24.2 h, (P) under bar < 0.001). Escalation (51.1 +/- 26.4 h versus 16.9 +/- 15.7 h, <(P)under bar> < 0.001) and de-escalation (63.1 +/- 39.5 h versus 39.2 +/- 25.6 h, <(P)under bar> < 0.01) of therapy were shorter in the postimplementation group. TOT for patients with multidrug-resistant organisms (MDROs) was shorter in the postimplementation group (61.8 +/- 372 h versus 21.9 +/- 18.8 h, <(P)under bar> < 0.001). TOT was shorter during fully staffed clinical pharmacist hours (30.6 +/- 58.9 h versus 19.7 +/- 31.7 h. p = 0.014). Implementation of RDT and surveillance software with an ASP decreased TOT for Gram-negative BSIs, including MDROs. (C) 2020 Elsevier Inc. All rights reserved.