Assadian Ojan, Diab-Elschahawi Magda, Makristathis Athanasios, Blacky Alexander, Koller Walter, Adlassnig Klaus-Peter
Clinical Institute for Hygiene and Medical Microbiology, Medical University of Vienna, Division of Hospital Hygiene, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
BMC Med Inform Decis Mak. 2009 Jun 7;9:27. doi: 10.1186/1472-6947-9-27.
The outcome of patients with bacteraemia is influenced by the initial selection of adequate antimicrobial therapy. The objective of our study was to clarify the influence of different crude data correction methods on a) microbial spectrum and ranking of pathogens, and b) cumulative antimicrobial susceptibility pattern of blood culture isolates obtained from patients from intensive care units (ICUs) using a computer based tool, MONI.
Analysis of 13 ICUs over a period of 7 years yielded 1427 microorganisms from positive results. Three different data correction methods were applied. Raw data method (RDM): Data without further correction, including all positive blood culture results. Duplicate-free method (DFM): Correction of raw data for consecutive patient's results yielding same microorganism with similar antibiogram within a two-week period. Contaminant-free method (CFM): Bacteraemia caused by possible contaminants was only assumed as true bloodstream infection, if an organism of the same species was isolated from > 2 sets of blood cultures within 5 days.
Our study demonstrates that different approaches towards raw data correction - none (RDM), duplicate-free (DFM), and a contaminant-free method (CFM) - show different results in analysis of positive blood cultures. Regarding the spectrum of microorganisms, RDM and DFM yielded almost similar results in ranking of microorganisms, whereas using the CFM resulted in a clinically and epidemiologically more plausible spectrum.
For possible skin contaminants, the proportion of microorganisms in terms of number of episodes is most influenced by the CFM, followed by the DFM. However, with exception of fusidic acid for gram-positive organisms, none of the evaluated correction methods would have changed advice for empiric therapy on the selected ICUs.
菌血症患者的治疗结果受初始恰当抗菌治疗选择的影响。我们研究的目的是使用基于计算机的工具MONI，阐明不同原始数据校正方法对以下方面的影响：a）微生物谱和病原体排名，以及b）从重症监护病房（ICU）患者获得的血培养分离株的累积抗菌药敏模式。
对13个ICU进行为期7年的分析，从阳性结果中获得了1427株微生物。应用了三种不同的数据校正方法。原始数据法（RDM）：不做进一步校正的数据，包括所有阳性血培养结果。无重复法（DFM）：对连续患者在两周内产生相同微生物且药敏谱相似的结果进行原始数据校正。无污染物法（CFM）：仅当在5天内从>2套血培养中分离出相同物种的微生物时，才将可能的污染物引起的菌血症假定为真正的血流感染。
我们的研究表明，对原始数据进行校正的不同方法——不校正（RDM）、无重复（DFM）和无污染物法（CFM）——在阳性血培养分析中显示出不同的结果。关于微生物谱，RDM和DFM在微生物排名方面产生了几乎相似的结果，而使用CFM则产生了临床上和流行病学上更合理的谱。
对于可能的皮肤污染物，就发作次数而言，微生物比例受CFM影响最大，其次是DFM。然而，除了对革兰氏阳性菌的夫西地酸外，所评估的校正方法均不会改变所选ICU经验性治疗的建议。
