Why Are You “Dying” for Your Laboratory Culture Results?

Every day sick patients are treated in hospitals with broad spectrum antibiotics while their physicians wait days for culture results to identify infectious pathogen susceptibility to confirm or revise the treatment protocol.

Unfortunately, many of these patients (especially those with sepsis) do not survive long enough to receive the precise life-saving drug and/or dosage needed. Furthermore, the over prescribing of broad-spectrum antibiotics, while awaiting a specific diagnosis, is also a contributing factor to the rise of antimicrobial resistance as well as Clostridium difficile.   

What makes this scenario even more disturbing is the fact that fast susceptibility technology results available in hours, not days, can guide patient-specific antibiotic treatment.  The technology is currently available and is an emerging evidence-based standard of care that hospitals and clinicians should adopt to improve patient outcomes and enhance antimicrobial stewardship programs.

Undoubtedly the adoption of any new technology involves some risk; however, adhering to evidence based practice requires keeping abreast of new technologies, procedures, and clinical data.  Relying only on what is customary in medical practice would result in the stagnation of advancements in healthcare.

In addition, there is potential liability for failing to stay informed of current best practices. There is ample case law to support the concept that liability will be attached to failure to adopt new technologies or procedures even when not yet “customary” in the field.

So why is there so much lag time and reluctance to adopt available fast susceptibility technology when this process strengthens existing antibiotic stewardship programs with a subsequent positive impact upon C. difficile incidence?  The sad truth is that inertia in healthcare is endemic and usually begins with the words, “this is how we have always done it”.

However, most clinicians are typically so overburdened that they rarely have the time or the inclination to study every new technology.  The burden therefore has traditionally fallen upon the medical device and technology companies to bring awareness through education, clinical trials, and publications using early adopters as their emissaries to change practice.

The question then becomes: Can we afford to wait for gradual adoption of fast susceptibility technology in a world of increasingly deadly antimicrobial resistant pathogens?

We can’t afford to wait, and it’s not just me saying this. The CDC, WHO, APIC, IDSA, TJC and a myriad of other healthcare organizations have urged all acute care facilities to adopt antimicrobial stewardship programs and a core element of these programs is the monitoring of antibiotic prescribing and resistance patterns as well as education on optimal prescribing.  Healthcare leaders must take action to address the increasing problem of multi-drug resistant organisms that are leaving the arsenal of antimicrobials ineffective.

Who would ever believe that something called “sepsis” is now America’s costliest health condition with one million people hospitalized each year (more than heart disease and stroke combined) and in 2013, nearly $5.5 billion was spent on patients hospitalized with sepsis.1,2

With faster susceptibility technology, speed to de-escalation can provide a cost-effective improvement in patient outcomes.   Adoption of innovative technology in the hospital laboratory can bring about real change resulting in a new standard of care.  Healthcare leaders serious about limiting drug resistance and improving patient care will never again have to say, “If only we had the culture results…”

1- Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Statistical Brief No. 204; May 2016. National inpatient hospital costs: the most expensive conditions by payer, 2013.

2- https://www.sepsis.org/sepsis-alliance-news//new-u-s-government-report-reveals-annual-cost-of-hospital-treatment-of-sepsis-has-grown-by-3-4-billion

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