infection control & hospital epidemiology july 2017, vol. 38, no. 7 concise communication
Pharmacists’ Familiarity with and Institutional Utilization of Rapid Diagnostic Technologies for Antimicrobial Stewardship
Rachel A. Foster, PharmD, MBA;1 Kristi Kuper, PharmD, BCPS;2 Z. Kevin Lu, PhD;1 P. Brandon Bookstaver, PharmD, FCCP, FIDSA, BCPS, AAHIVP;1 Christopher M. Bland, PharmD, FCCP, FIDSA, BCPS;3 Monica V. Mahoney, PharmD, BCPS (AQ-ID)4
Rapid diagnostic technologies (RDTs) significantly reduce organism identification time and can augment antimicrobial stewardship program (ASP) activities. An electronic survey quantified familiarity with and utilization of RDTs by clinical pharmacists participating in ASPs. Familiarity was highest with polymerase chain reaction (PCR). Formal infectious diseases training was the only significant factor influencing RDT familiarity.
Infect Control Hosp Epidemiol 2017;38:863–866
tested by 3 clinical pharmacists and was distributed via e-mail to members of the Society of Infectious Diseases Pharmacists (SIDP) and the Infectious Diseases Practice and Research Network (ID-PRN) of the American College of Clinical Pharmacy (ACCP). Respondents had 4 weeks to complete the survey. A reminder e-mail was sent at 2 weeks, participation was optional, and responses were anonymous. The primary objectives of this study were to evaluate respon-
A key component of antimicrobial stewardship programs (ASPs) is streamlining antimicrobial therapy based on culture and susceptibility testing results. Traditional culture methods may take 72 hours to finalize, and test interpretation may be influenced by microbiologists’ expertise. Technological advances have reduced causative organism identification time.1 Implementation of rapid diagnostic tests (RDTs) combined with active ASP interventions is associated with reduced time to appropriate antimicrobial therapy, decreased length of stay (LOS) and healthcare costs, and improved clinical outcomes, including mortality.2,3 ASP members may not be aware of the breadth or scope of
RDTs available, including pharmacists. According to the 2014 National Healthcare Safety Network Hospital (NHSN) survey, pharmacists are most commonly responsible for improving inpatient antimicrobial use.4 To our knowledge, familiarity with RDTs has not been previously reported. We sought to evaluate pharmacists’ familiarity with and utilization of available RDTs designed to aid in ASP activities.
methods
This cross-sectional electronic survey targeting pharmacists involved in ASP activities was approved by the institutional review board. A 19-item RedCap electronic survey (Online Supplementary Material) examined the respondents’ RDT knowledge and institutional utilization. The survey was pilot
dents’ familiarity with and institutional use of RDT in ASP activities: polymerase chain reaction (PCR), multiplex PCR, nucleic acid extraction/PCR amplification (NA PCR), peptide nucleic acid fluorescent in situ hybridization (PNA FISH), and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). All surveys with at least 33% completion (including 5 items regarding familiarity with and utilization of RDTs) were analyzed. Demographics, actions sec- ondary to positive RDTs, and reported RDT outcomes were evaluated. Familiarity with various RDTs was assessed via a 5- point Likert scale from 1 (completely unfamiliar) to 5 (very familiar). Survey results were summarized, and Likert-scale responses were reported with descriptive statistics. Respondent results were further grouped by formal infectious diseases (ID) training (yes/no) and institution type (academic medical center, community hospital, other) for analysis of potential differences in RDT familiarity. Formal ID training was defined as comple- tion of an ID post-graduate year 2 pharmacy residency or fel- lowship. Differences between groups were analyzed using χ2 tests (α=0.05). Multivariate logistic regressions were conducted to assess risk factors associated with respondents’ familiarity status.
results
We received a total of 224 responses representing 46 states and 9 countries. Respondents most commonly had <10 years in practice and worked at a community hospital. Overall, 101 of 224 respondents (45.1%) reported formal ID training, and 81 of 224 respondents (36.2%) had completed stewardship- related certificate programs. In addition, 152 of 173 respon- dents (87.9%) worked at a facility with ≥0.5 ASP-dedicated FTE, and 127 of 174 respondents (73.0%) had RDT for <3 years. Full demographics are shown in Table 1. Self-reported utilization of RDTs varied: multiplex PCR was
used in 94 institutions (42.1%), MALDI-TOF was used in 74 institutions (33.2%), PCR was used in 67 institutions (30.0%), PNA FISHwas used in 29 institutions (13%), andNAPCRwas used in 24 institutions (10.8%). Furthermore, 44 respondents (19.7%) indicated no current use of RDTs. The most notable discrepancy was among the 74 MALDI-TOF users, where 44 teaching hospitals (59%) utilized this RDT, compared to 22 community hospitals (30%) and 8 other institutions (11%). Respondent’s self-reported familiarity (defined as somewhat familiar or very familiar) with RDT types was ranked.
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