Automated alerts coupled with antimicrobial stewardship intervention lead to decreases in length of stay in patients with gram-negative bacteremia

Jason M. Pogue, Ryan P. Mynatt, Dror Marchaim, Jing J. Zhao, Viktorija O. Barr, Judy Moshos, Bharath Sunkara, Teena Chopra, Sowmya Chidurala, Keith S. Kaye

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE. To assess the impact of active alerting of positive blood culture data coupled with stewardship intervention on time to appropriate therapy, length of stay, and mortality in patients with gram-negative bacteremia. DESIGN. Quasi-experimental retrospective cohort study in patients with gram-negative bacteremia at the Detroit Medical Center from 2009 to 2011. SETTING. Three hospitals (1 community, 2 academic)with active antimicrobial stewardship programs within the Detroit Medical Center. PATIENTS. All patients with monomicrobial gram-negative bacteremia during the study period. INTERVENTION. Active alerting of positive blood culture data coupled with stewardship intervention (2010-2011) compared with patients who received no formalized stewardship intervention (2009). RESULTS. Active alerting and intervention led to a decreased time to appropriate therapy (8 [interquartile range (IQR), 2-24] vs 14 [IQR, 2-35] hours; P =.014) in patients with gram-negative bacteremia. After controlling for differences between groups, being in the intervention arm was associated with an independent reduction in length of stay (odds ratio [OR], 0.73 [95% confidence interval (CI), 0.62-0.86]), correlating to a median attributable decrease in length of stay of 2.2 days. Additionally, multivariate modeling of patients who were not on appropriate antimicrobial therapy at the time of initial culture positivity showed that patients in the intervention group had a significant reduction in both length of stay (OR, 0.76 [95% CI, 0.66-0.86]) and infection-related mortality (OR, 0.24 [95% CI, 0.08-0.76]). CONCLUSIONS. Activealertingcoupledwithstewardshipinterventioninpatientswithgram-negativebacteremiapositivelyimpactedtime to appropriate therapy, length of stay, and mortality and should be a target of antimicrobial stewardship programs.

Original languageEnglish
Pages (from-to)132-138
Number of pages7
JournalInfection Control and Hospital Epidemiology
Volume35
Issue number2
DOIs
StatePublished - Feb 2014
Externally publishedYes

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