You get a nudge, and you get a nudge! The impact of a microbiology comment on the treatment of Streptococcus pneumoniae bloodstream infections

Document Type

Conference Proceeding

Publication Date

1-11-2026

Publication Title

Open Forum Infect Dis

Keywords

ampicillin, antibiotic agent, ceftriaxone, immunoglobulin E, penicillin derivative, steroid, vancomycin, adult, all cause mortality, antibiotic sensitivity, bloodstream infection, clinical outcome, cohort analysis, conference abstract, drug therapy, endocarditis, female, hospice care, hospital readmission, human, intensive care unit, intravenous drug administration, length of stay, major clinical study, male, maximum permissible dose, meningitis, nonhuman, pneumococcal infection, polymerase chain reaction, Streptococcus pneumoniae, therapy

Abstract

Background: Bloodstream infection (BSI) occurs in 25-30% of pneumococcal disease. For nonmeningeal S. pneumoniae infections, ampicillin or penicillin demonstrate 97% susceptibility on local antibiograms but are not commonly prescribed. The study purpose was to assess the impact of a microbiology nudge comment on narrowspectrum antibiotic use in patients with S. pneumoniae BSI. Variables associated with de-escalation to narrow-spectrum at 48-hrs in patients with Streptococcus pneumoniae BSI. Methods: This was an IRB-approved, single pre-, post-test, quasi-experiment conducted at a five-hospital health system from 10/1/2022 to 9/26/2023 (pre-nudge) and 0/1/2023 to 9/26/2024 (post-nudge). On 9/27/2023, a microbiology nudge was appended to rapid blood polymerase chain reaction (PCR) results: 'Drugs of choice = Ampicillin IV or Penicillin IV. For meningitis, use max dose Ceftriaxone IV plus Vancomycin IV until susceptibilities known'. Inclusion: hospitalized adults >18 years with confirmed S. pneumoniae BSI. Exclusion: IgE-mediated or severe cutaneous β-lactam allergy, polymicrobial infection, comfort/hospice care, death <48-hrs of culture, suspected/confirmed meningitis, or endocarditis. The primary outcome was deescalation to narrow-spectrum antibiotics within 48-hrs of rapid blood PCR results, defined as IV penicillin or IV ampicillin. Secondary outcomes included all-cause mortality, in-hospital mortality, duration of broad-spectrum antibiotics, and length of hospital/ICU stay. Results: 105 patients were included; 54% pre-nudge, 51% post-nudge. Narrow-spectrum antibiotic use at 48-hrs increased from 29.6% to 66.7% (P< 0.001), oral switch increased from 35.2% to 56.9% (P=0.026). Broad spectrum antibiotic use decreased from a median (IQR) of 8 (4-12) to 3 days (1-9) (P< 0.001). Secondary outcomes including hospital length of stay, 30-day all-cause mortality, and 30-day all-cause readmission, were not different between groups. Median (IQR): 8 (5-16) vs. 6 (4-10) days (P=0.083); 1.9% vs 7.8% (P=0.150); and 16.7% vs. 7.8% (P=0.170) respectively. After adjustment for steroids, the post-nudge group was independently associated with narrow-spectrum de-escalation (Table 1). Conclusion: Implementation of a microbiology nudge was associated with an increase in 48-hr de-escalation to narrow-spectrum for S. pneumoniae BSI, without an observed increase in negative clinical outcomes.

Volume

13

First Page

S610

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