1809. Improved Vancomycin Utilization With Rapidly Available Xpert MRSA/SA BC PCR and Microbiologist Case Review
Bibliographic record
Abstract
Staphylococcus aureus bloodstream infections are life threatening, and are empirically treated with vancomycin. Our objective was to assess the impact of a rapidly available PCR for methicillin-resistant S. aureus (MRSA) on the amount and duration of vancomycin use in methicillin-sensitive S. aureus (MSSA) bloodstream infections. In October 2016, the Xpert® MRSA/SA BC assay, a PCR to detect MRSA from blood cultures, was implemented at Kelowna General Hospital. MRSA PCR was performed on one bottle per episode for blood cultures with Gram-positive cocci in clusters in at least 3/4 bottles. The medical microbiologist promptly phoned the most responsible physician with results to streamline antibiotics. All episodes of MSSA bacteremia between January 1, 2013 to September 30, 2016 (pre-implementation group) and November 1, 2016 to January 31, 2018 (post-implementation group), were matched to corresponding vancomycin defined daily doses (DDD) and days of therapy (DOT) in pharmacy records. Patients with ≥5 DOTs were excluded if they had allergies to β-lactams, polymicrobial infections with organisms requiring vancomycin, were on hemodialysis (vancomycin convenience dosing), or were transferred from another hospital with known S. aureus bacteremia. Mean vancomycin DDDs and DOTs, and the proportion of patients receiving at least one dose of vancomycin, were compared between groups. Categorical variables were analyzed using the chi-square test, while continuous variables were compared using the t-test. In the pre-PCR group, 383 episodes of MSSA bacteremia were identified, with 21 excluded. In the post-PCR group, 100 episodes were found, with 3 excluded. Significantly more patients received at least one dose of vancomycin in the pre-PCR (70.2%) compared with the post-PCR group (54.6%) (P < 0.01). The mean DDD was 1.5 in the post-PCR group, less than the pre-PCR group at 2.8 (P < 0.01). The mean DOT also decreased, with the post-PCR group receiving less vancomycin (1.6 days) compared with the pre-PCR group (2.5 days) (P < 0.01). Rapidly available MRSA PCR for S. aureus bloodstream infection coupled with antimicrobial stewardship performed by medical microbiologists led to a significant decrease in vancomycin use. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.008 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".