P-1701. Characterizing 24-Hour Pharmacist Response to Rapid Multiplex Polymerase Chain Reaction (rmPCR) Blood Culture Results

TL;DR

This study examined how 24-hour pharmacist coverage affects responses to rapid blood culture results, finding consistent response times and therapy modifications across all shifts.

Contribution

The study demonstrates consistent pharmacist response and therapy modification rates across all 24-hour shifts for rmPCR blood culture results.

Findings

No significant difference in therapy modification rates across shifts (31%, 38%, and 24%).

No significant difference in time to pharmacist intervention or time to optimal therapy across shifts.

Pharmacists were more likely to intervene for methicillin-susceptible Staphylococcus aureus and less likely with infectious disease consults.

Abstract

Rapid molecular polymerase chain reaction (rmPCR)-based blood cultures with pharmacist-driven response have been studied with differing means of communication and limited hours of pharmacist coverage. Our study aimed to characterize 24-hour pharmacist response to rmPCR blood culture results with a focus on response differences between shifts and time to optimal antibiotics.Table 1Baseline CharacteristicsTable 2Primary and Secondary Outcomes

Baseline Characteristics

Primary and Secondary Outcomes

This retrospective chart review included patients ≥19 years old with positive blood cultures admitted to East Alabama Medical Center. Patients were excluded if they were pregnant, incarcerated, discharged or transitioned to comfort care within 8 hours of blood culture notification, if they died within 24 hours of blood culture notification, or had rmPCR results with Streptococcus species, Streptococcus agalactiae, Cryptococcus, or Enterobacterales. Pharmacists were alerted to positive rmPCR results via electronic medical record task list and made antibiotic recommendations based on in-house guidelines. Shifts were divided as follows: first (0700-1459), second (1500-2259), and third (2300-0659). The primary outcome was the percentage of patients requiring therapy modification. Secondary outcomes included time to pharmacist intervention and time to optimal therapy.Table 3Bivariate Analysis

Bivariate Analysis

In total, 120 patients were included: 55 in first shift, 40 in second shift, and 25 in third shift. Baseline characteristics were similar among the three groups. There was no difference in the primary outcome: 17 patients required therapy modification in the first shift group (31%), 15 (38%) in second shift, and 6 (24%) in third shift (p=0.516). There was no difference in time to pharmacist intervention (p=0.062) or time to optimal therapy (p=0.219) across shifts. Pharmacists were more likely to intervene on patients with methicillin-susceptible Staphylococcus aureus (odds ratio [OR] 5.7, 95% confidence interval [CI] 1.60 to 20.74) and less likely to intervene on patients with an infectious disease consult (OR 0.21, 95% CI 0.084 to 0.530). Pharmacist shift was not associated with likelihood of intervention.

Our study showed a similar need for therapy modification and similar response times across shifts, highlighting the value of 24-hour pharmacist review of rmPCR results.

All Authors: No reported disclosures

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