Outcomes from implementation of rapid identification test for detection of gram-positive and gram-negative bacteria into a pharmacist-directed antimicrobial stewardship protocol for pediatric patients

Introduction: The rapid identification of microorganisms is paramount for targeted antibiotic treatment for serious bloodstream infections (BSI). The automated nanoparticle probe microarray-based nucleic acid test is an assay for Gram-Positive Blood Culture (BC-GP) and Gram-Negative Blood Culture (BC-GN) that identifies bacterial targets and resistance markers in 2.5 hours from positive blood cultures. These molecular technologies have significantly reduced the time to optimal antibiotics in adults, but data is lacking for pediatric population.

Objectives:  To evaluate the outcomes from implementation of a rapid microarray assay for bacterial identification in combination with a pharmacist-directed antimicrobial stewardship protocol in pediatric patients in a tertiary-care hospital.

Study Design: A multi-center, quasi-experimental study is currently being conducted in all pediatric patients with positive blood cultures that were tested with automated microarray BC-GP and/or BC-GN assay at Lutheran Hospital since the implementation on April 30, 2015.

Methods:   A clinical pharmacist was informed of the microarray assay results and effective antibiotics were recommended based on targeted treatment chart.  Pediatric population included: neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), and general pediatric floor. Data collection included: age, gender, length of stay, date/time of blood sample collections, date/time of rapid BC-GP and/or BC-GN assay results, date/time of final culture results, date/time of antibiotic orders, date/time of antibiotic discontinuation, physician notification, and pharmacist intervention.  Outcomes were assessed for pediatric patients with positive blood cultures tested with rapid BC-GP and/or BC-GN assay compared with time to traditional culture results. The primary outcomes were mean time to optimal antibiotic therapy following assay results and mean time antibiotics were avoided before final culture results.

Results: Data collection is in progress.  

Conclusions: Preliminary data suggests that microarray technology and antimicrobial stewardship can decrease the time to appropriate antibiotics in pediatric patients with positive blood cultures.