Impact of Pharmacist-Led Review and Intervention of Positive Blood Culture

Abstract

Background. The development of rapid diagnostic testing for pathogen identification has proven beneficial in strengthening antimicrobial stewardship efforts to ensure judicious antibiotic use. However, existing data evaluating the impact of proactive bloodstream infection (BSI) review by pharmacists on clinical outcomes is limited. The aim of this study is to evaluate the impact of pharmacist proactive review utilizing rapid organization identification tools on patient outcomes with positive BSI. Methods. This is a single-center, two-phase retrospective study comparing a 3-month period pre- and post-implementation of rapid diagnostic tests in conjunction with active interventions by the infectious disease (ID) pharmacy team. Adult patients older than 18 years of age with select BSI identified via matrix assisted laser desorption/ ionization time-of-flight (MALDI-TOF) and chromogenic media were included. During the intervention period, pharmacists were proactively notified daily by microbiology lab with organism identification results. The primary objective was time to optimal antimicrobial therapy in hours. Secondary objectives included clinical outcome, select antibiotic usage, and pharmacist interventions. Results. A total of 238 unique patients were included in the final analysis: 112 patients in the intervention group and 126 patients in the historical control group. Pharmacist interventions with rapid diagnostic tests showed decreased time to optimal therapy (51.3 vs 38.3 hours, P 0.03) and improved time to organism identification (42.2 vs 17.6 hours, P < 0.0001). There were no differences between 30 day all-cause mortality, 30 day readmission rates with the same BSI, and overall hospital length of stay. Lastly, patients with pharmacist interventions with rapid diagnostics were found to have a decrease in intensive care unit LOS (10.8 vs 5.9 days, P 0.02). Out of the 126 patients during the intervention group, 68 (53%) were intervened by the pharmacist with a 96% acceptance rate by prescribers. Conclusion. Utilization of rapid diagnostics tests in conjunction with pharmacistguided proactive blood culture review led to significant reductions in time to organism identification and optimal therapy.