Lessons learned from implementation of an electronic decision support tool for hospital-administered pneumococcal vaccinations.

Experts recommend standing orders for hospital-administered vaccines to improve adult immunization rates. We implemented an admission assessment tool to offer pneumococcal vaccine to eligible hospitalized patients. We retrospectively reviewed vaccines for guideline concordance and found that immunization rates increased but less than half of study patients received the correct vaccine.

Randomized Trial Evaluating Clinical Impact of RAPid IDentification and Susceptibility Testing for Gram-negative Bacteremia: RAPIDS-GN.

Background: Rapid blood culture diagnostics are of unclear benefit for patients with gram-negative bacilli (GNB) bloodstream infections (BSIs). We conducted a multicenter, randomized, controlled trial comparing outcomes of patients with GNB BSIs who had blood culture testing with standard-of-care (SOC) culture and antimicrobial susceptibility testing (AST) vs rapid organism identification (ID) and phenotypic AST using the Accelerate Pheno System (RAPID).

Methods: Patients with positive blood cultures with Gram stains showing GNB were randomized to SOC testing with antimicrobial stewardship (AS) review or RAPID with AS.

Clinical impact of switching conventional enzyme immunoassay with nucleic acid amplification test for suspected Clostridium difficile-associated diarrhea.

The impact of a new Clostridium difficile nucleic acid amplification test (NAAT) on antibiotic utilization in patients with suspected C difficile infection was assessed. This single-center, cross-sectional study of 270 patients demonstrated that the use of NAAT decreased antibiotic expenditure by reducing prolonged empiric days of therapy in these patients.

Practical therapeutic application of the oxoid PBP2' latex agglutination test for the rapid identification of methicillin-resistant Staphylococcus aureus in blood cultures.

The Oxoid PBP2' latex agglutination test (OLA; Oxoid, Basingstoke, England) was evaluated in a controlled prospective study examining Staphylococcus aureus from 25 positive blood cultures. Subcultures of positive blood cultures with coagulase-positive, gram-positive cocci in clusters were batched, and the OLA was performed at the end of the working day, once growth was seen on the plate. Results were sent to the infectious disease pharmacist for therapy evaluation, and the 24-hour minimum inhibitory concentration (MIC) was confirmed the next day.