Antimicrobial stewardship aids in reducing the emergence of multi-drug resistant organisms (MDRO) and enhances clinical outcomes through optimization of antimicrobial use. Broad spectrum antibiotics are started in the case of sepsis and are often not deescalated in a timely fashion. A protocol was designed to integrate a comprehensive blood culture identification (BCID) test into our antimicrobial stewardship program to determine if we could decrease our broad spectrum antibiotic use.

Our microbiology lab in collaboration with the hospital's antimicrobial stewardship team implemented a rapid BCID polymerase chain reaction (PCR) test. The microbiology lab would run the test in tandem with the Gram-stain when a blood culture was positive. The results were then reported to the nurse and a pharmacist. The pharmacist would make an immediate recommendation to the provider on how to manage the current antibiotic regimen based on the results using a pre-approved algorithm. Data were retrospectively reviewed and included time to antibiotic deescalation, broad-spectrum antibiotic days, length of stay, and cost avoidance. Data were collected for four months before and after implementation from 01/01/2017 to 08/31/2017. Descriptive statistics were utilized to analyze the data.

A total of 99 patients before and 103 patients after were assessed. Time to antibiotic deescalation decreased by 25 hours after implementation (45% reduction). We avoided a total of 70 broad-spectrum antibiotic days and observed a length of stay reduction of 1.45 days. Based on the length of stay reduction, a cost avoidance of $322,508 over the 4 months was calculated. Cost data was derived from the average cost per patient day at our institution.

The BCID combined with antibiotic stewardship resulted in rapid antibiotic adjustment (average 25 hours sooner), decrease in broad spectrum antibiotic use, and decreased length of stay for patients with bacteremia.