Objectives
    1.  Describe recent advancements in microbiology 
        rapid diagnostic testing
    2.  Review current literature describing the impact of 
        rapid diagnostic testing on antimicrobial 
        stewardship and patient outcomes 
    3.  Evaluate the incorporation of rapid diagnostics into 
        an antimicrobial stewardship program to identify 
        positive blood cultures
                  Case 1
  HPI: MJ is a 68 YO M end stage renal disease (ESRD) on hemodialysis 
  (HD) (MWF) presents to ER from HD clinic after he was noted to have 
  chills, rigors, and a fever of 102.1. In the ER he is lethargic and febrile. 
  The ER sent 2 sets of blood cultures. 
  PMH: ESRD on HD (HD catheter), Diabetes, Hypertension
  Allergy: penicillin (GI upset) 
  Medications: Insulin glargine, metoprolol, zolpidem prn, docusate, senna
  Social history: Denies IVDA, no tobacco, no alcohol 
                   Case 1
  The microbiology lab performed a gram stain and notifies 
    the ER that both sets of MJ’s blood cultures have gram 
    positive cocci in clusters.
    Which empiric antibiotic should be started?
  The microbiology lab set up MJ’s blood cultures on the 
    BioFire FilmArray. The team was notified that the patient’s 
    blood cultures are growing Staphylococcus aureus mecA 
    negative.
    What (if any) changes should be made to MJ’s antibiotic 
     regimen?
     Antimicrobial Stewardship Program (ASP)
    ID Physician         Clinical       Microbiology
                       Pharmacist
              Information 
               Systems        Epidemiologist
               Specialist
            Early Antibiotic Administration 
   
     Septic shock 
      Acute organ dysfunction secondary to documented or 
       suspected infection
      Major health care issue
   
     Effective antimicrobial administration
      Impact on mortality
      Timing is important 
      Selection is important