Clinical and implementation outcomes of an antimicrobial stewardship intervention for rapid blood culture diagnostics

Objective: To evaluate the clinical and implementation outcomes of an antimicrobial stewardship program (ASP) intervention to improve antibiotic therapy for a rapid diagnostic test (RDT) for bloodstream infections (BSIs). Design: Retrospective pre and postintervention study. Setting: Single pediatric tertiary center from August 2022 to May 2024. Participants: Patients presenting with a positive blood culture accompanied by the Verigene (VG) Gram-positive Blood Culture Nucleic Acid (BC-GP) assay. Implementation outcomes surveys were completed by infectious diseases (ID) clinicians and non-ID clinicians. Methods: We implemented a 24 hours a day, 7 days a week (24/7) ASP intervention to improve response to BC-GP assay results. The primary clinical end point was time to optimal antimicrobial therapy (OAT). Secondary endpoints included duration of bacteremia, hospital length of stay (LOS), and mortality. We assessed our intervention’s acceptability, appropriateness, and feasibility using validated implementation outcomes surveys. Results: Among 211 pre and 91 postimplementation BC-GP results, the median time to OAT decreased from 20.3 hours (95% CI:14.2–26.4) to 1.3 hours (95% CI: 0.0–2.7), p = .002. No significant differences were found in duration of bacteremia, LOS, or mortality. Implementation surveys from 23 ID and 47 non-ID clinicians demonstrated over 80% agreement on intervention appropriateness and acceptability. ID clinicians rated feasibility measures lower than non-ID clinicians (3.58 vs 4.51 on a five-point Likert scale, p < .001). Conclusions: 24/7 ASP intervention paired with RDTs for Gram-positive BSIs is associated with reduced time to OAT. Feasibility differences between ID and non-ID clinicians highlight implementation challenges and the need for future strategy evaluation.