gms | German Medical Science

Background: Bloodstream infections (BSIs) caused by multidrug-resistant gram negative rods (MDR-GNRs) are an increasing healthcare problem worldwide, especially in immunocompromised patients. Early diagnosis and adequate and prompt therapy have great impact in the clinical outcome of these patients.

Objectives: To improve the clinical outcomes of cancer patients with MDR-GNR BSI through the initiation of adequate, prompt and early antimicrobial therapy. The goal of this process was to decrease the timeframe from final susceptibility of blood culture to the initiation of adequate therapy.

Methods: MDR-GNRs were defined by presence of ESBL or resistance to ≥ 3 of 4 groups (3rd–4th generation cephalosporins, carbapenems, piperacillin/tazobactam and/or fuoloquinolones). Resistance to carbapenems alone was also a criterion for MDR-Pseudomonas.

Since July 15, 2012, we have started the following quality improvement (QI) process: a) All GNR BSI results reported by microbiology laboratory were checked daily by an Infection Preventionist (IP); b) The IP notified the Infectious Diseases (ID) team members when a patient with a MDR-GNR BSI was identified; c) An ID physician/team member notified the primary team of the MDR-GNR BSI by email; d) The primary team decided whether or not to place an online ID consultation request; and e) A system was developed to prospectively collect data. As a control group, we retrospectively reviewed all MDR-GNR BSI cases from Jan’10 to Jul’12.

Results: Our QI process was conducted from July 16, 2012 to July 15, 2013. We improved ID consult requests from 60.6 % to 76.3 % (p=0.004), active therapy from 95.7 % to 98.3 % (p=0.003), timeframe from final susceptibility to active therapy from 11.00 hours to 7.53 hours (p=0.048), infection-related ICU admissions from 16.2 % to 3.9 % (p=0.018), and infection-related mortality from 15.4 % to 4.9 % (p=0.041), respectively.

Conclusion: This process has increased the number of early ID consultations and reduced the timeframe from the report of the final susceptibility to initiation of active therapy. This QI intervention has a favorable impact on clinical outcome, playing a role in the reduction of infection-related ICU admission, infection-related mortality and overall mortality in our cancer patients.