采用快速聚合酶链反应对抗凝固酶阴性葡萄球菌阳性血培养的抗菌药物管理药剂师干预措施。
Antimicrobial stewardship pharmacist interventions for coagulase-negative staphylococci positive blood cultures using rapid polymerase chain reaction.
机构信息
Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
出版信息
Ann Pharmacother. 2012 Nov;46(11):1484-90. doi: 10.1345/aph.1R439. Epub 2012 Nov 7.
BACKGROUND
No studies exist regarding the value of pharmacist interventions using rapid identification of coagulase-negative staphylococci (CoNS) by rapid polymerase chain reaction (rPCR) from blood cultures.
OBJECTIVE
To evaluate the impact of interventions by infectious diseases pharmacists (ID PharmDs) on blood cultures positive for CoNS using rPCR and assess the duration of antistaphylococcal antibiotic therapy, hospital length of stay (LOS), and related costs.
METHODS
A quasi-experimental, pre- and postintervention study of patients with positive blood cultures for CoNS, identified using rPCR, was conducted. Patients were included if there was a blood culture for CoNS from January 1, 2011, to March 31, 2011 (preintervention), or October 1, 2011, to January 18, 2012 (postintervention). Exclusion criteria included age younger than 18 years or 89 years or older, neutropenia, incomplete records, and duplicate or mixed blood cultures. The setting was a 1200-bed academic medical center. The ID PharmD intervened on blood cultures identified in the postintervention group as CoNS after notification from the microbiology laboratory. The pre- and postintervention groups were compared to analyze the effect of the intervention. The primary outcome was time to discontinuation of antistaphylococcal antibiotics by the pharmacist intervention in patients with a positive blood culture for CoNS that was determined to be a contaminant.
RESULTS
We analyzed 53 patients (31 preintervention, 22 postintervention) with CoNS blood culture contaminants. In the postintervention group, antistaphylococcal antibiotics were discontinued 32.0 hours sooner from time of rPCR result (median 57.7 vs 25.7 hours; p = 0.005), total antibiotic exposure decreased 43.5 hours (97.6 vs 54.1 hours; p = 0.011), infection-related LOS decreased 4.5 days (10 vs 5.5 days; p = 0.018), and infection-related costs decreased $8338 ($28,973 vs $20,635; p = 0.144). The pharmacist initiated vancomycin in 7 (21.9%) patients with CoNS bloodstream infections.
CONCLUSIONS
Timely interventions by ID PharmDs using rPCR are required to impact the outcomes of patients with positive blood cultures for CoNS.
背景
目前尚无研究探讨使用快速聚合酶链反应（rPCR）从血培养物中快速鉴定凝固酶阴性葡萄球菌（CoNS）对药剂师干预的价值。
目的
评估传染病药师（ID PharmD）对 CoNS 血培养物阳性患者进行干预的效果，评估抗葡萄球菌抗生素治疗的持续时间、住院时间（LOS）和相关费用。
方法
采用准实验性、干预前后研究设计，对使用 rPCR 鉴定的 CoNS 血培养阳性患者进行研究。如果患者在 2011 年 1 月 1 日至 3 月 31 日（干预前）或 2011 年 10 月 1 日至 2012 年 1 月 18 日（干预后）有 CoNS 血培养阳性，则纳入研究。排除标准包括年龄<18 岁或>89 岁、中性粒细胞减少症、记录不完整、血培养重复或混合。研究地点为 1200 床位的学术医疗中心。ID PharmD 在接到微生物实验室的通知后，对干预后组的 CoNS 血培养物进行干预。对比分析干预前后组，以分析干预效果。主要结局指标为 ID PharmD 干预 CoNS 血培养物污染患者的抗葡萄球菌抗生素停药时间。
结果
我们分析了 53 例（干预前 31 例，干预后 22 例）CoNS 血培养物污染患者。在干预后组，rPCR 结果后抗葡萄球菌抗生素停药时间提前 32.0 小时（中位数 57.7 比 25.7 小时；p=0.005），总抗生素暴露时间减少 43.5 小时（97.6 比 54.1 小时；p=0.011），感染相关 LOS 减少 4.5 天（10 比 5.5 天；p=0.018），感染相关费用减少 8338 美元（28973 比 20635 美元；p=0.144）。ID PharmD 对 7 例（21.9%）CoNS 血流感染患者启动了万古霉素治疗。
结论
及时进行 ID PharmD 干预，对 CoNS 血培养阳性患者的结局有重要影响。
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