Efficiency of the Verigene® Blood Culture System on Time to Infection Control Barrier Precautions in Bacteremic Patients with Multidrug-Resistant Organisms

Abstract

Background. Multidrug resistant (MDR) infections are a significant cause of morbidity, mortality, and excess cost in healthcare institutions, leading to the implementation of infection control barrier precautions geared to prevent transmission. Rapid diagnostic tests (RDT) provide prompt identification of microorganisms and resistance markers, offering a unique collaborative opportunity for both infection control and antimicrobial stewardship programs (ASPs). We evaluated the effect of RDT coupled with an ASP communication on time to placement of contact isolation in bacteremic patients with MDR organisms. Methods. RDT was performed using Verigene® Blood Culture System (Northbrook, IL) for gram-positive and gram-negative microorganisms. Results were reported to the infectious diseases pharmacist and the corresponding practitioner caring for the patient, and an appropriate treatment regimen per protocol was selected. A retrospective chart review was performed to compare management of bacteremic patients with MDR organisms before and after implementation of the Verigene® System. MDR was defined as acquired nonsusceptibility to at least o1ne agent in 3 or more antimicrobial classes. The primary endpoint was time to initiation of barrier precautions. Results. Fifty-seven patients with MDR bacteremia were included in our analysis; 25 in the pre-RDT group and 32 in the post-RDT group. The following MDR organisms were isolated from culture in the pre-RDT and post-RDT group respectively: methicillin resistant Staphylococcus aureus (36 % versus 47%), vancomycin resistant Enterococcus spp. (20% versus 3%), extended-spectrum beta-lactamase producing Enterobacteriaceae (36% versus 25%) and carbapenem-resistant Enterobacteriaceae (8% versus 25%). After initiation of RDT, there was a decrease in time to initiation of barrier precautions (4 hours 14 minutes [4:14 h:min; IQR, 1:48-12:16] versus 28:44 h:min [IQR, 4:05-49:25] p < 0.0006). Conclusion. RDT coupled with an antimicrobial stewardship communication resulted in faster initiation of infection control barrier precautions, with potential implications for improved efforts to reduce the spread and transmission of healthcareassociated MDR infections. Further studies are warranted to confirm these results.