Optimizing Antimicrobial Timing: The Impact of Real-Time Pharmacist Review of Blood Cultures

Abstract

Bacteremia is a potentially life-threatening infection, especially if sepsis or septic shock develops. The 2021 Surviving Sepsis Campaign recommends initiating antibiotics within the first hour for septic shock to improve patient outcomes. The objective of this study is to assess the clinical impact of real-time pharmacist review of blood culture polymerase chain reaction (PCR) results. This single-center, retrospective cohort study included patients admitted with a positive blood culture PCR result that was not covered with the appropriate antimicrobials at the time of the result. The cultures without a pharmacist’s review were from calendar year 2021, while the post-intervention group’s cultures were obtained throughout 2024. The primary endpoint was the time to appropriate antimicrobial coverage. A total of 303 patients were included, with 151 in the pre-intervention group and 152 in the post-intervention group. The post-intervention group notably had a higher number of resistant gram-negative isolates compared to the pre-intervention group (65 isolates [74.7%], (vs) 35 isolates [55.6%], P = .02). The median time to appropriate antimicrobial coverage improved from 10.6 hours in the pre-intervention group to 3.8 hours in the post-intervention group (P < .001). All-cause mortality decreased numerically (34 patients [22.5%] in the pre-group vs 27 patients [17.8%] in the post-group, P = .32). The time to appropriate antimicrobial coverage improved after the implementation of real-time pharmacist review of blood cultures. Although the decrease in mortality was not statistically significant, most patients who expired grew resistant organisms, which were more prevalent in the post-intervention group.