Using rapid diagnostic tests (RDTs) and algorithm-based stewardship recommendations to manage coagulase-negative Staphylococcus bloodstream infection (CoNS BSI) was associated with a significant reduction in antibiotic days of therapy, researchers reported today in Open Forum Infectious Diseases.
For the study, researchers from Rutgers University and the University of Pittsburgh analyzed consecutive patients with blood cultures positive for Staphylococcus species over three independent 4-month periods. The first period was prior to implementation of RDTs, the second was a post-RDT/pre-algorithm period, and the third was a prospective post-RDT/post-algorithm period.
The aim was to see whether rapid identification of CoNS, which is a common blood contaminant but doesn't always cause BSIs, combined with an algorithm-based stewardship approach, could lower rates of antibiotic use.
A total of 182 patients with CoNS bacteremia were included in the study, with 65 in the pre-RDT period, 60 in the post-RDT/pre-algorithm period, and 57 in the post-RDT/post-algorithm period. Overall, 69%, 19%, and 12% of cases were classified as simple, uncomplicated, or complicated cases of CoNS bacteremia, respectively.
Significant reduction in antibiotic days of therapy (DOT) were observed in the post-RDT/post-algorithm period but not in the post-RDT/pre-algorithm period. While median DOT did not vary significantly for patients with simple, uncomplicated, or complicated bacteremia between the first two periods, median DOT was reduced to 0 for simple CoNS BSIs during the post-RDT/post-algorithm period.
The percentage of patients who received antibiotics for less than 24 hours rose from 33% in the first two periods to 54% in the post-RDT/post-algorithm period, and antibiotics were avoided entirely in 28% of CoNS cases in the post-RDT/post-algorithm periods, compared with 15% in the first two periods.
Pairing [rapid diagnostic tests] with early algorithm-based management can significantly reduce healthcare resource utilization.
The overall 30-day, all-cause mortality rate (14.2%) did not vary across cohorts.
"These data have major implications considering that even with robust stewardship efforts and targeted communication, nearly 87% of patients with contaminated blood cultures receive antibiotics for an average of 7 days and stay in the hospital for a median duration of 7 days," the study authors wrote. "Thus, pairing RDT with early algorithm-based management can significantly reduce healthcare resource utilization."