Study: Clinical Pharmacist Recommendations Increased with Rapid Diagnostic Testing in Community Hospitals

Patients more quickly received antimicrobial therapy for gram positive bacteremia and candidemia after rapid diagnostic testing in 2 community hospital settings; however, testing had no effect on the amount of time therapy became effective, according to a study presented in a poster session at the 2019 American Society of Hospital Pharmacists (ASHP) Summer Meeting & Exhibitions in Boston, MA. Rapid diagnostic testing also resulted in providers receiving a large increase in pharmacist recommendations.

Leroy Koh of Houston Methodist Hospital in Texas and colleagues’ evaluative study looked at 140 patients in a pre-intervention group admitted between November 2017 and May 2018, and 124 patients in an intervention group admitted between July 2018 and January 2019. Patients were age 18 years or older and had tested positive for gram positive bacteremia with Staphylococcus aureus, Enterococcus faecalis or faecium, or Candida species.

Investigators reported that the baseline demographics of the 2 groups were well matched. Patients excluded from the study included those who had antibiotics before their blood samples were taken, patients who died or transferred from the hospital before testing positive, or who had mixed positive blood cultures before being admitted.

The intervention of real time pharmacists occurred in June 2018 at 1 hospital and in July 2018 at the other. Investigators reported a decrease in the mean time of effective therapy from 13.9 +/- 21.6 hours and 8.6 +/- 12.5 hours in the pre-intervention and intervention groups respectively. They noted that the pre-intervention group saw a significant decrease (53.7 +/- 57.7 hours) in optimal therapy time, while the intervention group saw a decrease from 38.4 +/- 31.5 hours.

In addition to optimal therapy and time to therapy, secondary outcomes examined patient mortality, length of stay, and clinical pharmacist interventions. Koh and colleagues reported both groups had a similar mortality rate of 5%, and that the mean length of stay ranged between 11.0 +/- 7.2 days for the pre-intervention group and 10.3 +/-5.4 days for the intervention group. Clinical pharmacist recommendations more than doubled (18.6% pre-intervention versus 50.8% intervention).

“The results showed that the allocation of limited manpower resources of a community hospital to such a stewardship program is justifiable and could encourage more community hospitals to follow suit in the future,” investigators concluded.

Reference

Koh, L, Shah P, Korulla A, Perez K, Janak C. Will the incorporation of rapid diagnostic tests with pharmacist involvement improve time to antimicrobial therapy for gram positive bacteremia and candidemia in two community hospitals? Presented at: 2019 ASHP Summer Meetings & Exhibition (Session # 24-T; Abstr 191-192). June 8-10, 2019. Boston, MA.