This article is a collaboration between 番茄社区 and:
NEW ORLEANS -- A rapid blood culture system combined with an antibiotic stewardship program resulted in cost savings as well as improved outcomes for a small community hospital, researchers found here.
Under the new system, patients with Staphylococcus aureus bacteremia were identified and treated more quickly compared with patients under the old system, reported Marijo Roiko, PhD, of Altru Health System in Grand Forks, N.D., and colleagues.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
At a at the ASM Microbe meeting, co-author Susan Kuntz, PhD, told 番茄社区 that the cost savings incurred already paid for the laboratory instruments required to make this change.
"They cost $72,000, and we were at $100,000 savings for the healthcare system within about 3-4 months," she said. "It was amazing how well it fit into our workload. It was a little more work at first, but it was a process and it worked really well."
The authors estimated an average 3-day reduction in the length of hospital stay, and an estimated saving of $4,290 per patient, although ICU and other ancillary costs were not determined, they noted.
This small, retrospective study compared outcomes for patients with S. aureus bacteremia prior to and after the implementation of a rapid blood culture identification panel simultaneously with an antibiotic stewardship program.
Prior to implementation of the new panel, a daily review of positive blood cultures was performed by a pharmacist and infectious diseases physician, pending availability. With the new system (FilmArray BCID), blood cultures were reported to the ordering provider and also to the antibiotic stewardship pharmacist or on-call hospital pharmacist.
The authors examined 33 adult patients from both the old and new systems. Patients were a mean age of 64 in the old system and 60 in the new system, with over 20 men in each group. About 40% of patients in both groups tested positive for methicillin-resistant S. aureus (MRSA) bacteremia.
Overall, 30-day readmission dropped from 25% to 11% once the new system was implemented, with 30-day mortality exhibiting smaller declines (16% versus 13%). Length of stay also declined among all patients with S. aureus bacteremia (12.7 days versus 9.6 days). Examining patients by type of bacteria, similar declines were observed:
- Methicillin-susceptible S. aureus (20 patients per group): 11.1 days versus. 8.7 days
- MRSA (13 patients per group): 15 days versus. 11.9 days
The hospital cut time to deescalation by 2 days (3 days versus 1 day). The percentage of patients who were eligible for deescalation, but without deescalation, decreased under the new system, dropping from 30% to 25%.
Stephen Jenkins, MD, of Weill Cornell Medicine and New York-Presbyterian Hospital in New York City, who was not involved with the research, told 番茄社区 that the interesting thing is that the authors were able to show positive results for this type of program that wasn't at a large hospital.
"One of the questions everyone has had is can you do this in a small medical center. If they can show a significant difference with a small number of patients, I'm sure it would be more significant with a larger number," said Jenkins, who was not involved in the study.
Kuntz said given the successes with the antibiotic stewardship program in the hospital, the next step would be to examine their outpatient stewardship program "to see if we can make an impact there, as well."
Primary Source
ASM Microbe
Roiko M, et al "Positive impact of rapid blood culture identification and antibiotic stewardship for patients with S. aureus bacteremia at a community hospital" ASM Microbe 2017; Abstract 449.