Optimization of Empirical Antimicrobial Therapy in Enterobacterales Bloodstream Infection Using the Extended-Spectrum Beta-Lactamase Prediction Score

Author:

Haimerl Brian J.1ORCID,Encinas Rodrigo1ORCID,Justo Julie Ann23ORCID,Kohn Joseph3,Bookstaver P. Brandon23ORCID,Winders Hana Rac3ORCID,Al-Hasan Majdi N.14ORCID

Affiliation:

1. Department of Medicine, University of South Carolina School of Medicine, Columbia, SC 29209, USA

2. Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA

3. Department of Pharmacy, Prisma Health-Midlands, Columbia, SC 29203, USA

4. Department of Internal Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC 29203, USA

Abstract

Clinical tools for the prediction of antimicrobial resistance have been derived and validated without examination of their implementation in clinical practice. This study examined the impact of utilization of the extended-spectrum beta-lactamase (ESBL) prediction score on the time to initiation of appropriate antimicrobial therapy for bloodstream infection (BSI). The quasi-experimental cohort study included hospitalized adults with BSI due to ceftriaxone-resistant (CRO-R) Enterobacterales at three community hospitals in Columbia, South Carolina, USA before (January 2010 to December 2013) and after (January 2014 to December 2019) implementation of an antimicrobial stewardship intervention. In total, 45 and 101 patients with BSI due to CRO-R Enterobacterales were included before and after the intervention, respectively. Overall, the median age was 66 years, 85 (58%) were men, and 86 (59%) had a urinary source of infection. The mean time to appropriate antimicrobial therapy was 78 h before and 46 h after implementation of the antimicrobial stewardship intervention (p = 0.04). Application of the ESBL prediction score as part of an antimicrobial stewardship intervention was associated with a significant reduction in time to appropriate antimicrobial therapy in patients with BSI due to CRO-R Enterobacterales. Utilization of advanced rapid diagnostics may be necessary for a further reduction in time to appropriate antimicrobial therapy in this population.

Publisher

MDPI AG

Subject

Pharmacology (medical),Infectious Diseases,Microbiology (medical),General Pharmacology, Toxicology and Pharmaceutics,Biochemistry,Microbiology

Reference24 articles.

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3. Extended-spectrum beta-lactamases: A clinical update;Paterson;Clin. Microbiol. Rev.,2005

4. World Health Organization (2023, May 03). WHO Publishes List of Bacteria for Which New Antibiotics Are Urgently Needed. Available online: https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed.

5. Burden of bacterial bloodstream infection-a brief update on epidemiology and significance of multidrug-resistant pathogens;Kern;Clin. Microbiol. Infect.,2020

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