Fédération de Microbiologie Clinique, Assistance Publique des Hôpitaux de Marseille-Pôle des Maladies Infectieuses, Hôpital la Timone, Marseille, France.
PLoS One. 2011;6(7):e22403. doi: 10.1371/journal.pone.0022403. Epub 2011 Jul 19.
Clinical microbiology may direct decisions regarding hospitalization, isolation and anti-infective therapy, but it is not effective at the time of early care. Point-of-care (POC) tests have been developed for this purpose.
One pilot POC-lab was located close to the core laboratory and emergency ward to test the proof of concept. A second POC-lab was located inside the emergency ward of a distant hospital without a microbiology laboratory. Twenty-three molecular and immuno-detection tests, which were technically undemanding, were progressively implemented, with results obtained in less than four hours. From 2008 to 2010, 51,179 tests yielded 6,244 diagnoses. The second POC-lab detected contagious pathogens in 982 patients who benefited from targeted isolation measures, including those undertaken during the influenza outbreak. POC tests prevented unnecessary treatment of patients with non-streptococcal tonsillitis (n = 1,844) and pregnant women negative for Streptococcus agalactiae carriage (n = 763). The cerebrospinal fluid culture remained sterile in 50% of the 49 patients with bacterial meningitis, therefore antibiotic treatment was guided by the molecular tests performed in the POC-labs. With regard to enterovirus meningitis, the mean length-of-stay of infected patients over 15 years old significantly decreased from 2008 to 2010 compared with 2005 when the POC was not in place (1.43±1.09 versus 2.91±2.31 days; p = 0.0009). Altogether, patients who received POC tests were immediately discharged nearly thrice as often as patients who underwent a conventional diagnostic procedure.
The on-site POC-lab met physicians' needs and influenced the management of 8% of the patients that presented to emergency wards. This strategy might represent a major evolution of decision-making regarding the management of infectious diseases and patient care.
临床微生物学可以指导住院、隔离和抗感染治疗决策，但在早期护理时效果不佳。为此开发了即时检测（POC）测试。
一个试点 POC 实验室靠近核心实验室和急诊病房，用于测试概念验证。第二个 POC 实验室位于没有微生物学实验室的远程医院的急诊病房内。逐步实施了 23 种技术要求不高的分子和免疫检测测试，结果在不到四个小时内获得。2008 年至 2010 年，进行了 51179 次测试，得出了 6244 个诊断结果。第二个 POC 实验室在 982 名患者中检测到了传染性病原体，这些患者受益于针对性的隔离措施，包括在流感爆发期间采取的措施。POC 测试避免了对非链球菌性扁桃体炎患者（n=1844）和携带无乳链球菌阴性的孕妇（n=763）进行不必要的治疗。在 49 名细菌性脑膜炎患者中，50%的脑脊液培养结果为无菌，因此抗生素治疗由 POC 实验室进行的分子测试指导。对于肠道病毒脑膜炎，与 2005 年未设立 POC 时相比，2008 年至 2010 年，15 岁以上感染患者的平均住院时间显著缩短（1.43±1.09 天比 2.91±2.31 天；p=0.0009）。总的来说，接受 POC 测试的患者几乎是接受常规诊断程序的患者的三倍，立即出院。
现场 POC 实验室满足了医生的需求，并影响了 8%就诊于急诊病房的患者的治疗管理。这种策略可能代表着传染病管理和患者护理决策的重大演变。
