Impact of QuickFISH in addition to antimicrobial stewardship on vancomycin use and resource utilization in cancer patients with coagulase-negative staphylococcal blood cultures Journal Article


Authors: Seo, S. K.; Gedrimaite, Z.; Paskovaty, A.; Seier, K.; Morjaria, S.; Cohen, N.; Riedel, E.; Tang, Y. W.; Babady, N. E.
Article Title: Impact of QuickFISH in addition to antimicrobial stewardship on vancomycin use and resource utilization in cancer patients with coagulase-negative staphylococcal blood cultures
Abstract: Objective: To evaluate the impact of rapidly identifying coagulase-negative staphylococci (CoNS) from positive blood cultures combined with an established antimicrobial stewardship (AS) programme at a tertiary cancer centre. Methods: We compared cancer patients ≥18 years old who between 01/1/13 and 12/31/13 had one or more positive CoNS blood culture(s) identified by Staphylococcus QuickFISH® (a peptide nucleic acid fluorescence in situ hybridization assay) with cancer patients ≥18 years old who had CoNS identified by standard microbiological techniques between 01/01/11 and 12/31/11 (baseline). Positive blood culture results were reported to the clinician by microbiology staff; restricted antibiotics (e.g., vancomycin) required approval by the AS team. Results: There were 196 baseline and 103 QuickFISH patients. Faster median time to organism identification (33 (IQR 27–46) versus 49 (IQR 39–63) hours, p < 0.001), more vancomycin avoidance (51/103 (50%) versus 60/196 (31%), p 0.002), shorter median antibiotic duration (1 (IQR 0–3) versus 2 (IQR 0–6) days, p 0.019), fewer central venous catheter (CVC) removals (14/78 (18%) versus 57/160 (36%), p 0.004), and reduced vancomycin level monitoring (16/52 (31%) versus 71/136 (52%), p 0.009) were observed in the QuickFISH group. QuickFISH implementation was predictive of a lower likelihood of antibiotic therapy prescription (OR 0.35, 95%CI 0.20–0.62, p < 0.001). Prior transplant (RR 1.47, 95%CI 1.13–1.92, p 0.004), neutropenia (RR 1.47, 95%CI 1.09–1.99, p 0.012), multiple positive blood cultures (RR 4.23, 95%CI 3.23–5.54, p < 0.001), and CVC (RR 1.60, 95%CI 1.02–2.53, p 0.043) were independent factors for antibiotic duration. Conclusions: QuickFISH implementation plus AS support leads to greater avoidance of vancomycin therapy and improved resource utilization in cancer patients with CoNS blood cultures. © 2018 European Society of Clinical Microbiology and Infectious Diseases
Keywords: vancomycin; blood culture; staphylococcus; coagulase-negative; quickfish
Journal Title: Clinical Microbiology and Infection
Volume: 24
Issue: 12
ISSN: 1198-743X
Publisher: Elsevier Inc.  
Date Published: 2018-12-01
Start Page: 1339.e7
End Page: 1339.e12
Language: English
DOI: 10.1016/j.cmi.2018.03.006
PUBMED: 29549061
PROVIDER: scopus
PMCID: PMC6136986
DOI/URL:
Notes: Article -- Export Date: 3 December 2018 -- Source: Scopus
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MSK Authors
  1. Ngolela Esther Babady
    66 Babady
  2. Susan Seo
    59 Seo
  3. Yi-Wei Tang
    124 Tang
  4. Kenneth Seier
    18 Seier