Standardization in the management of gram-negative bloodstream infections after implementation of a clinical care guideline at a large academic, safety-net institution: A quasi-experimental study

Abstract

Objective: To evaluate the impact of implementing a clinical care guideline for uncomplicated gram-negative bloodstream infections (GN-BSI) within a health system. Design: Retrospective, quasi-experimental study. Setting: A large academic safety-net institution. Participants: Adults (≥18 years) with GN-BSI, defined by at least one positive blood culture for specific gram-negative organisms. Patients with polymicrobial cultures or contaminants were excluded. Interventions: Implementation of a GN-BSI clinical care guideline based on a 2021 consensus statement, emphasizing 7-day antibiotic courses, use of highly bioavailable oral antibiotics, and minimizing repeat blood cultures. Results: The study included 147 patients pre-intervention and 169 post-intervention. Interrupted time series analysis showed a reduction in the median duration of therapy (-2.3 days, P =.0016), with a sustained decline (slope change -0.2103, P =.005) post-intervention. More patients received 7 days of therapy (12.9%-58%, P