Antibiotic stewardship bundle for uncomplicated gram-negative bacteremia at an academic health system: a quasi-experimental study

• Main Authors: Juliana DiPietro (Author), Yanina Dubrovskaya (Author), Kassandra Marsh (Author), Arnold Decano (Author), John Papadopoulos (Author), Dana Mazo (Author), Kenneth Inglima (Author), Vincent Major (Author), Jonathon So (Author), Samuel Yuditskiy (Author), Justin Siegfried (Author)
• Format: Book
• Published: Cambridge University Press, 2024-01-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

Abstract Objective: To evaluate whether an antimicrobial stewardship bundle (ASB) can safely empower frontline providers in the treatment of gram-negative bloodstream infections (GN-BSI). Intervention and Method: From March 2021 to February 2022, we implemented an ASB intervention for GN-BSI in the electronic medical record (EMR) to guide clinicians at the point of care to optimize their own antibiotic decision-making. We conducted a before-and-after quasi-experimental pre-bundle (preBG) and post-bundle (postBG) study evaluating a composite of in-hospital mortality, infection-related readmission, GN-BSI recurrence, and bundle-related outcomes. Setting: New York University Langone Health (NYULH), Tisch/Kimmel (T/K) and Brooklyn (BK) campuses, in New York City, New York. Patients: Out of 1097 patients screened, the study included 225 adults aged ≥18 years (101 preBG vs 124 postBG) admitted with at least one positive blood culture with a monomicrobial gram-negative organism. Results: There was no difference in the primary composite outcome (12.9% preBG vs. 7.3% postBG; P = 0.159) nor its individual components of in-hospital mortality, 30-day infection-related readmission, and GN-BSI recurrence. Vancomycin (VAN) discontinuation (DC) was done more frequently by the primary team in postBG (37.9% vs 66.7%; P < 0.001). In postBG, de-escalation done by the primary team increased by 8.8%, P = 0.310 and there was an 11.1% increase in the use of aminopenicillin-based antibiotics, P = 0.043. Conclusions: GN-BSI bundle worked as a nudge-based strategy to guide providers in VAN DC and increased de-escalation to aminopenicillin-based antibiotics without negatively impacting patient outcomes.

Item Description

10.1017/ash.2024.395
2732-494X