Impact of antimicrobial stewardship and rapid diagnostics in children with Staphylococcus aureus bacteremia

IntroductionRapid diagnostic testing (RDT) in combination with antimicrobial stewardship programs (ASPs) has been associated with improved outcomes in adults with Staphylococcus aureus bacteremia (SAB); however, pediatric data are limited. ObjectivesThe primary objective of this study was to assess the clinical impact of concomitant implementation of an ASP and RDT in children with SAB. MethodsThis pre-post quasi-experimental study compared time to optimal antibiotic in children with SAB in 2015/2016 (pre-intervention [PRE]) and 2017/2018 (post-intervention [POST]). During the PRE period there was no RDT or ASP available. However, in the POST period, RDT was performed on all positive blood cultures, followed by feedback from an ASP. Secondary outcomes included time to effective antibiotic, antibiotic exposure, duration of bacteremia, hospital length of stay (LOS), transfer to the intensive care unit (ICU), SAB recurrence, and inpatient mortality. ResultsSixty-eight patients were included in the study (PRE: n = 32, POST: n = 36). Median time to optimal antibiotic therapy decreased by 23 hours (PRE: 44.3 hours vs POST: 21.3 hours; P = .008). Duration of bacteremia (PRE: 65 hours vs POST: 40.9 hours; P = .03) and inpatient mortality (PRE: 12.5% vs POST: 0%; P = .04) were also reduced. However, further review revealed that only one death was related to SAB. Differences in time to effective therapy, antibiotic exposure, and hospital LOS were not significantly different between the groups. There were similar rates of infectious disease (ID) consultation (PRE: 78% vs POST: 89%, P = .23), but a shorter time to central line removal in the POST group (PRE: 68.2 hours vs POST: 19.8 hours; P = .04). Throughout the study period, recurrence of SAB only occurred in one patient (PRE). ConclusionASP interventions, facilitated by RDT, resulted in a shorter time to optimal antibiotic therapy in children with SAB. Although these interventions may have led to improved overall SAB management, further studies are needed to confirm clinical benefits.