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Related Concept Videos

Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

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Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
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One-day Workflow Scheme for Bacterial Pathogen Detection and Antimicrobial Resistance Testing from Blood Cultures
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Implementation of a pharmacy-driven rapid bacteremia response program.

Ashley M Wilde1, Matthew Song1, W Paul Allen2

  • 1Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY, USA.

American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
|September 2, 2023
PubMed
Summary
This summary is machine-generated.

A new pharmacy program significantly reduced the time to effective antibiotic therapy for bacteremia by enabling pharmacists to rapidly respond to critical diagnostic results, improving patient care.

Keywords:
antimicrobial stewardshipbacteremiaclinical pharmacy servicecommunity hospitalspharmacistsrapid diagnostic test

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Area of Science:

  • Clinical Pharmacy
  • Infectious Diseases
  • Microbiology

Background:

  • Bacteremia requires timely and effective antimicrobial therapy.
  • Traditional response times to microbiologic results can delay optimal treatment.
  • Expanding the role of pharmacists can enhance patient care and outcomes.

Purpose of the Study:

  • To describe a comprehensive pharmacy-driven rapid response program for bacteremia.
  • To evaluate the impact of this program on the time to effective therapy.
  • To assess the role of pharmacists in optimizing antibiotic regimens based on diagnostic results.

Main Methods:

  • Implementation of a 24/7/365 pharmacy service to receive and act on critical microbiologic results.
  • Pharmacist-led assessment of Gram stain and rapid molecular diagnostic test results.
  • Protocol-driven antibiotic adjustments, ordering of repeat cultures, and communication with treatment teams.
  • Tracking of blood culture Gram stain and rapid diagnostic test result utilization.

Main Results:

  • The program processed 2,282 blood culture Gram stains and 2,046 rapid diagnostic tests in the first year.
  • Median time to effective therapy decreased from over 10 hours to under 1 hour for patients without prior antimicrobial orders.
  • Antibiotics were initiated per protocol in 34.2% of patients based on Gram stain results.
  • Antibiotic regimens were adjusted in 55.7% of cases based on rapid diagnostic test results, with nearly equal rates of escalation and de-escalation.

Conclusions:

  • A pharmacy-driven rapid response program effectively optimizes antibiotic therapy for bacteremia.
  • Expanding pharmacy practice scope overcomes barriers to timely and effective clinical care.
  • This model demonstrates significant improvements in patient management and antimicrobial stewardship.