Standardization in the management of gram-negative bloodstream infections after implementation of a clinical care guideline at a large academic, safety-net institution: a quasi-experimental study
Abstract Objective: To evaluate the impact of implementing a clinical care guideline for uncomplicated gram-negative bloodstream infections (GN-BSI) within a health system. Design: Retrospective, quasi-experimental study. Setting: A large academic safety-net institution. Participants: Adults...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2025-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X2500004X/type/journal_article |
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| author | Michael A. Deaney Katherine C. Shihadeh Alexandra Craig Margaret M. Cooper Paul D. Paratore Timothy C. Jenkins |
| author_facet | Michael A. Deaney Katherine C. Shihadeh Alexandra Craig Margaret M. Cooper Paul D. Paratore Timothy C. Jenkins |
| author_sort | Michael A. Deaney |
| collection | DOAJ |
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Abstract
Objective:
To evaluate the impact of implementing a clinical care guideline for uncomplicated gram-negative bloodstream infections (GN-BSI) within a health system.
Design:
Retrospective, quasi-experimental study.
Setting:
A large academic safety-net institution.
Participants:
Adults (≥18 years) with GN-BSI, defined by at least one positive blood culture for specific gram-negative organisms. Patients with polymicrobial cultures or contaminants were excluded.
Interventions:
Implementation of a GN-BSI clinical care guideline based on a 2021 consensus statement, emphasizing 7-day antibiotic courses, use of highly bioavailable oral antibiotics, and minimizing repeat blood cultures.
Results:
The study included 147 patients pre-intervention and 169 post-intervention. Interrupted time series analysis showed a reduction in the median duration of therapy (–2.3 days, P = .0016), with a sustained decline (slope change –0.2103, P = .005) post-intervention. More patients received 7 days of therapy (12.9%–58%, P < .01), oral antibiotic transitions increased (57.8% vs 72.2%, P < .05), and guideline-concordant oral antibiotic selection was high. Repeat blood cultures decreased (50.3% vs 30.2%, P < .01) without an increase in recurrent bacteremia. No significant differences were observed in 90-day length of stay, rehospitalization, recurrence, or mortality.
Conclusions:
Guideline implementation was associated with shorter antibiotic therapy durations, increased use of guideline-concordant oral antibiotics, and fewer repeat blood cultures without compromising patient outcomes. These findings support the effectiveness of institutional guidelines in standardizing care, optimizing resource utilization, and promoting evidence-based practices in infectious disease management.
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| format | Article |
| id | doaj-art-96434516b9f1455fa792a8b1fe053a70 |
| institution | Kabale University |
| issn | 2732-494X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj-art-96434516b9f1455fa792a8b1fe053a702025-02-12T07:09:21ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2025-01-01510.1017/ash.2025.4Standardization in the management of gram-negative bloodstream infections after implementation of a clinical care guideline at a large academic, safety-net institution: a quasi-experimental studyMichael A. Deaney0https://orcid.org/0009-0007-8576-4964Katherine C. Shihadeh1https://orcid.org/0009-0003-9375-680XAlexandra Craig2https://orcid.org/0009-0006-3466-7825Margaret M. Cooper3https://orcid.org/0000-0003-1735-5468Paul D. Paratore4https://orcid.org/0000-0002-7017-241XTimothy C. Jenkins5Department of Pharmacy, Denver Health & Hospital Authority, Denver, CO, USADepartment of Pharmacy, Denver Health & Hospital Authority, Denver, CO, USADepartment of Pharmacy, Denver Health & Hospital Authority, Denver, CO, USADepartment of Pharmacy, Denver Health & Hospital Authority, Denver, CO, USADepartment of Pharmacy, Denver Health & Hospital Authority, Denver, CO, USADepartment of Medicine - Infectious Disease, Denver Health & Hospital Authority, Denver, CO, USA Abstract Objective: To evaluate the impact of implementing a clinical care guideline for uncomplicated gram-negative bloodstream infections (GN-BSI) within a health system. Design: Retrospective, quasi-experimental study. Setting: A large academic safety-net institution. Participants: Adults (≥18 years) with GN-BSI, defined by at least one positive blood culture for specific gram-negative organisms. Patients with polymicrobial cultures or contaminants were excluded. Interventions: Implementation of a GN-BSI clinical care guideline based on a 2021 consensus statement, emphasizing 7-day antibiotic courses, use of highly bioavailable oral antibiotics, and minimizing repeat blood cultures. Results: The study included 147 patients pre-intervention and 169 post-intervention. Interrupted time series analysis showed a reduction in the median duration of therapy (–2.3 days, P = .0016), with a sustained decline (slope change –0.2103, P = .005) post-intervention. More patients received 7 days of therapy (12.9%–58%, P < .01), oral antibiotic transitions increased (57.8% vs 72.2%, P < .05), and guideline-concordant oral antibiotic selection was high. Repeat blood cultures decreased (50.3% vs 30.2%, P < .01) without an increase in recurrent bacteremia. No significant differences were observed in 90-day length of stay, rehospitalization, recurrence, or mortality. Conclusions: Guideline implementation was associated with shorter antibiotic therapy durations, increased use of guideline-concordant oral antibiotics, and fewer repeat blood cultures without compromising patient outcomes. These findings support the effectiveness of institutional guidelines in standardizing care, optimizing resource utilization, and promoting evidence-based practices in infectious disease management. https://www.cambridge.org/core/product/identifier/S2732494X2500004X/type/journal_article |
| spellingShingle | Michael A. Deaney Katherine C. Shihadeh Alexandra Craig Margaret M. Cooper Paul D. Paratore Timothy C. Jenkins Standardization in the management of gram-negative bloodstream infections after implementation of a clinical care guideline at a large academic, safety-net institution: a quasi-experimental study Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Standardization in the management of gram-negative bloodstream infections after implementation of a clinical care guideline at a large academic, safety-net institution: a quasi-experimental study |
| title_full | Standardization in the management of gram-negative bloodstream infections after implementation of a clinical care guideline at a large academic, safety-net institution: a quasi-experimental study |
| title_fullStr | Standardization in the management of gram-negative bloodstream infections after implementation of a clinical care guideline at a large academic, safety-net institution: a quasi-experimental study |
| title_full_unstemmed | Standardization in the management of gram-negative bloodstream infections after implementation of a clinical care guideline at a large academic, safety-net institution: a quasi-experimental study |
| title_short | Standardization in the management of gram-negative bloodstream infections after implementation of a clinical care guideline at a large academic, safety-net institution: a quasi-experimental study |
| title_sort | standardization in the management of gram negative bloodstream infections after implementation of a clinical care guideline at a large academic safety net institution a quasi experimental study |
| url | https://www.cambridge.org/core/product/identifier/S2732494X2500004X/type/journal_article |
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