2025 Southeastern Residency Conference

Title: Comparison of Rapid Diagnostic Tests on Antibiotic Use in Gram-negative Bloodstream Infections within an Academic Health-system
Authors: Colter Sheveland, Cassie Ferguson, Sarah Al-Mansi, Kayla Antosz, Caroline Jozefczyk, Andrew Gainey, Robert Daniels, Joseph Kohn, Chenweng Teng, Anna-Kathryn Burch, Majdi Al-Hasan, Brandon Bookstaver
Background: Gram-negative bloodstream infections (GNBSIs) lead to significant morbidity and mortality. Technologic advances in rapid diagnostic tests for pathogen identification and antimicrobial susceptibility testing (AST) have enhanced the ability for clinicians to more promptly initiate patients on stewardship-conscience and appropriate antimicrobial therapy compared with traditional culture and susceptibility methodologies. The purpose of this study was to evaluate the antimicrobial stewardship program benefit of the addition of the Accelerate Pheno® (AP) system for rapid phenotypic AST with an existing blood culture identification multiplex polymerase chain reaction (BCID2®)/Vitek 2®/ matrix-assisted laser desorption/ionization time (MALDI) workflow.
Methods: An IRB-exempt, multi-centered, retrospective, pre-/post-cohort study was conducted in adult patients hospitalized with aerobic GNBSIs at one of four Prisma Health – Midlands major acute care facilities. Notable exclusions were patients with polymicrobial GNBSIs, those who left against medical advice, transferred to an outside facility, discharged home, or died prior to receipt of antibiotic therapy initiation or blood culture identification results. Baseline characteristics and endpoints were manually collected using a pre-specified REDCap form. The primary endpoint of the time to first appropriate streamlined therapy (FAST) was evaluated in the AP group from August 5, 2022 to October 31, 2022 and in the post-AP group from May 1, 2024 to July 31, 2024. Key secondary endpoints included discordances between AP-determined and BCID2®- or MALDI-determined pathogen identification, discordances between AP-determined and Vitek 2®-determined AST results, and time to de-escalation off carbapenems, anti-pseudomonal beta-lactams, and Gram-negative combination therapy. 
Results: In Progress
Conclusions: In Progress