Box Maggie J, Sullivan Eva L, Ortwine Kristine N, Parmenter Mark A, Quigley Michael M, Aguilar-Higgins Louise M, MacIntosh Cynthia L, Goerke Kristina F, Lim Rachel A
Department of Pharmacy, Scripps Health, San Diego, California.
Pharmacotherapy. 2015 Mar;35(3):269-76. doi: 10.1002/phar.1557.
Rapid diagnostics for bloodstream infections have been shown to improve outcomes. Most studies have focused on rapid diagnostics for a single pathogen and have been conducted in academic medical centers. The Verigene Gram-Positive Blood Culture Test (BC-GP) identifies 12 gram-positive organisms and 3 genetic markers of antibiotic resistance from positive blood culture media in 2.5 hours. This study evaluates implementation of the Verigene BC-GP panel in combination with real-time support from the Antibiotic Stewardship Team (AST) in a community hospital system.
This multicenter, pre-post, quasi-experimental study was conducted at the five hospitals that compose Scripps Healthcare. Rapid diagnostic testing was performed at a central laboratory from 7 a.m.-7 p.m. Pharmacists notified physicians of results and assisted with antibiotic modifications. The primary outcomes were average time to targeted antibiotic therapy and difference in antibiotic duration for contaminants. Secondary end points included hospital length of stay, mortality, pharmacy costs, and overall hospitalization costs. Adult patients with a gram-positive bacteremia admitted in 2011 (pre-rapid testing) were compared with those admitted in 2014 (post-rapid testing).
There were 103 patients in the preintervention group and 64 patients in the intervention group. The optimized identification process, combined with AST intervention, improved mean time to targeted antibiotic therapy (61.1 vs 35.4 hrs, p<0.001) and decreased mean duration of antibiotic therapy for blood culture contaminants (42.3 vs 24.5 hrs, p=0.03). Median length of stay (9.1 vs 7.2 days, p=0.04) and overall median hospitalization costs ($17,530 vs $10,290, p=0.04) were lower in the intervention group. Mortality was similar between groups (9.1% vs 9.2%, p=0.98).
Rapid identification of gram-positive blood cultures with AST intervention decreased time to targeted antibiotic therapy, length of unnecessary antibiotic therapy for blood culture contaminants, length of stay, and overall hospital costs.
血流感染的快速诊断已被证明可改善治疗结果。大多数研究集中于单一病原体的快速诊断，且是在学术医疗中心开展的。Verigene革兰氏阳性血培养检测（BC-GP）可在2.5小时内从阳性血培养培养基中鉴定出12种革兰氏阳性菌及3种抗生素耐药基因标记物。本研究评估了在社区医院系统中联合抗生素管理团队（AST）的实时支持来实施Verigene BC-GP检测板的情况。
这项多中心、前后对照、准实验性研究在构成斯克里普斯医疗集团的五家医院进行。快速诊断检测于上午7点至晚上7点在中心实验室进行。药剂师将检测结果告知医生，并协助调整抗生素使用。主要结局指标为靶向抗生素治疗的平均时间以及污染物抗生素使用时长的差异。次要终点包括住院时间、死亡率、药房费用及总体住院费用。将2011年（快速检测前）收治的革兰氏阳性菌血症成年患者与2014年（快速检测后）收治的患者进行比较。
干预前组有103例患者，干预组有64例患者。优化后的鉴定流程联合AST干预，缩短了靶向抗生素治疗的平均时间（61.1小时对35.4小时，p<0.001），并减少了血培养污染物的抗生素治疗平均时长（42.3小时对24.5小时，p=0.03）。干预组的住院中位时间（9.1天对7.2天，p=0.04）和总体住院中位费用（17,530美元对10,290美元，p=0.04）更低。两组间死亡率相似（9.1%对9.2%，p=0.98）。
通过AST干预快速鉴定革兰氏阳性血培养，可缩短靶向抗生素治疗时间、减少血培养污染物不必要的抗生素治疗时长、缩短住院时间并降低总体住院费用。
