3/10/2016. Faster Microbiology An Outcome Analysis. Disclaimer. Short Topic Objectives

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1 Faster Microbiology An Outcome Analysis James E. Lee, Ph.D. Disclaimer The views expressed are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense or the U.S. Government Short Topic Objectives Become familiar with some of the newest rapid microbiological techniques Learn about several measurable outcomes that can be used in justifying rapid microbiology instrumentation Discover how to apply outcomes based microbiology testing in your laboratory 1

2 Overall Goal of Microbiology What is it? Quicker identification = better outcome (sometimes) > Excellent Article Perez, et al, Arch Pathol Lab Med, Vol 137, Sept How do I treat it? Bacterial Antibiotic susceptibility New Technology Direct from sample ID Nucleic Acid Amplification and Identification > BioFire FilmArray, Torch Blood culture, Respiratory, CSF, GI > Cepheid GenXpert Healthcare associated infections, Specific infectious diseases, Factor II and V > Verigene Blood Culture, Enteric, Respiratory > Luminex Aries HSV, GBS New Technology MALDI-TOF MS Matrix-Assisted Laser Desorption/Ionization Time Of Flight Mass Spectrometry > Bruker microflex > Vitek MS 2

3 Measurable Outcomes What outcomes do we want to measure? Life Changing > Risk of reinfection/readmission > Risk of hospital acquired infection Public Health Considerations > Antibiotic suitability Multi-resistant organism delay Fiscal Considerations > Bed Days ICU, Ward, NICU, etc. > Antibiotic Cost Microbiology QI Project August December 2015 Data to be collected: Retrospective Data - August December 2014 (Null hypothesis) > Gram stain reported from time of draw > ID and susceptibility reported from time of draw Faster Blood Culture ID (Intervention) > Gram stain is reported > FilmArray ID is reported > Susceptibility reported Outcomes to be collected: Time to ID difference De-escalation upon ID Bed days ICU Days Excluded Patients: No pediatric patients (>18 y.o.) Life Expectancy <30 days or passed away in hospital 3

4 Retrospective Data - August December 2014 (Null hypothesis) 25 patients > Gram stain reported from time of draw 14.9 hours > ID and susceptibility reported 34.9 hours Intervention Group - August December 2015 Faster Blood Culture ID 29 patients > Gram stain is completed and reported 17.0 hours > FilmArray ID is done 18.3 hours > Susceptibility reported 34.9 hours Retrospective Time to ID > 34.9 hours (15-59 hrs) > Upon Admission Bed Days Average > 5.1 ICU Days Average > 1.1 De-escalation of antibiotic use > 10 Patients (40%) ~$8,000 savings Intervention Time to ID > 18.3 hours (11-28 hrs) > Upon Admission Bed Days Average > 7.6 ICU Days Average > 1.4 De-escalation of antibiotic use > 6 Patients (21%) ~$4,600 savings 4

5 What Happened? Better Data Selection Not stratified by age/illness/organism Solution Get more data Chief of Infectious Disease retired After15 years at our hospital Was notorious for closely following ID patients Solution Antibiotic Stewardship Committee Hospital information system and LIS are separate If a tree falls in the forest.. Solution New HIS in Feb 2017 hopefully Conclusion and Questions Far better it is to dare mighty things, to win glorious triumphs even though checkered by failure, than to rank with those poor spirits who neither enjoy nor suffer much because they live in the gray twilight that knows neither victory nor defeat. - Teddy Roosevelt 5