Nilsen Einar
Laboratory of Medical Microbiology, Molde Hospital, Molde, and Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway.
Scand J Infect Dis. 2012 Nov;44(11):860-5. doi: 10.3109/00365548.2012.689848. Epub 2012 Jul 25.
The increasing prevalence of antibiotic resistance is challenging established empirical treatments, making early identification and susceptibility determination more important. To avoid time-consuming overnight cultures, a previously published method for the rapid identification and susceptibility testing of blood cultures was instituted at Molde Hospital. The time saved compared to the standard method, and how often the results could have led to a change in the empirical antibiotic treatment compared to Gram stain from cultures, were evaluated.
All positive blood cultures with Gram-negative bacilli obtained between March and December 2010 were included in the study (n = 69). Accuracy and turn-around times were compared to those of the standard methods. The empirical antibiotic treatment was recorded when consulting the clinician about the results.
Correct identification was obtained in 66/69 (95.7%) of the isolates. Correct susceptibility determination was obtained in 758/759 (99.9%) of the tests. Oral reports to the clinician were given on average 11 h 22 min earlier for identification, and 10 h 51 min earlier for susceptibility determination, compared to the standard methods. With optimal handling we could have managed 17 h 26 min and 16 h 14 min, respectively. In 14/69 cases the empirical treatment included no effective or appropriate antibiotics. 7 of these 14 would not have been changed to working antibiotic treatment based on Gram stain alone.
The rapid method was found to be accurate and showed the potential for the initiation of effective antibiotic treatment more than 16 h earlier for 10% of the patients in this small sample.
抗生素耐药性的日益普遍对既定的经验性治疗提出了挑战，使得早期识别和药敏测定变得更加重要。为避免耗时的过夜培养，莫尔德医院采用了一种先前发表的血培养快速鉴定和药敏试验方法。评估了与标准方法相比节省的时间，以及与培养物革兰氏染色相比，结果能导致经验性抗生素治疗改变的频率。
纳入2010年3月至12月间所有分离出革兰氏阴性杆菌的阳性血培养物（n = 69）。将准确性和周转时间与标准方法进行比较。在向临床医生咨询结果时记录经验性抗生素治疗情况。
69株分离菌中有66株（95.7%）得到正确鉴定。759次试验中有758次（99.9%）得到正确的药敏测定结果。与标准方法相比，向临床医生的口头报告平均鉴定时间提前11小时22分钟，药敏测定时间提前10小时51分钟。通过优化处理，我们分别可以在17小时26分钟和16小时14分钟内完成。在69例病例中有14例的经验性治疗未包括有效的或合适的抗生素。这14例中有7例仅根据革兰氏染色不会改为有效的抗生素治疗。
在这个小样本中，发现快速方法准确，且对10%的患者显示出比标准方法提前超过16小时开始有效抗生素治疗的潜力。
