Beal Stacy G, Thomas Cody, Dhiman Neelam, Nguyen Daniel, Qin Huanying, Hawkins Jennifer M, Dekmezian Mhair, Benavides Raul
Department of Pathology and Laboratory Medicine (Beal, Thomas, Dekmezian, Benavides) and the Department of Pharmacy (Nguyen), Baylor University Medical Center at Dallas; med fusion Laboratory, Lewisville, Texas (Beal, Thomas, Dhiman, Dekmezian, Benavides); the Department of Quantitative Science, Baylor Health Care System, Dallas, Texas (Qin); and Baylor Research Institute, Dallas, Texas (Hawkins). Dr. Beal is now affiliated with the University of Florida Health Shands, Gainesville, Florida.
Proc (Bayl Univ Med Cent). 2015 Apr;28(2):139-43. doi: 10.1080/08998280.2015.11929214.
New technologies offer rapid identification of organisms and antimicrobial resistance markers in blood cultures several hours faster than conventional methods. We sought to determine whether implementation of the Verigene® Gram-Positive Blood Culture (BC-GP) assay paired with a well-defined results reporting algorithm would lead to earlier deescalation of empiric therapy for inpatients with methicillin-sensitive Staphylococcus aureus (MSSA) and vancomycin-resistant Enterococcus (VRE) bacteremia. The algorithm design focused on lessening the demand for pharmacist time by using electronic communications where possible. Our study compared inpatients with MSSA and VRE bacteremia from the time period before (pre-BC-GP) and after (post-BC-GP) implementation of the assay on June 25, 2013. The time from blood draw to identification and susceptibility results was decreased by 36.4 hours (P < 0.001) in the post-BC-GP group. The mean time from collection to the first dose of optimal antibiotics was reduced in the post-BC-GP group by 18.9 hours (P = 0.004) overall, with a 20.6-hour reduction (P = 0.009) for patients with MSSA and a 20.7-hour reduction (P = 0.077) for patients with VRE. Additionally, the percent of patients on empiric therapy who were placed on optimal antibiotics at any time after the Gram stain result was available increased from 64% (45/70) pre-BC-GP to 80% (43/54) post-BC-GP. The BC-GP led to an increased rate of deescalation of empiric antibiotics and a reduction in the time to optimal antibiotics for patients with MSSA and VRE bacteremia.
新技术能在数小时内快速鉴定血培养中的微生物和抗菌药物耐药性标志物，比传统方法快得多。我们试图确定实施Verigene®革兰氏阳性血培养（BC-GP）检测并结合明确的结果报告算法，是否会使甲氧西林敏感金黄色葡萄球菌（MSSA）和耐万古霉素肠球菌（VRE）菌血症住院患者的经验性治疗更早降级。算法设计侧重于尽可能通过电子通信减少药剂师的时间需求。我们的研究比较了2013年6月25日该检测实施前（BC-GP前）和实施后（BC-GP后）时间段内患有MSSA和VRE菌血症的住院患者。BC-GP后组从采血到鉴定和药敏结果的时间减少了36.4小时（P < 0.001）。BC-GP后组从采集到首次使用最佳抗生素的平均时间总体减少了18.9小时（P = 0.004），MSSA患者减少了20.6小时（P = 0.009），VRE患者减少了20.7小时（P = 0.077）。此外，在革兰氏染色结果出来后，接受经验性治疗且在任何时间接受最佳抗生素治疗的患者比例从BC-GP前的64%（45/70）增加到了BC-GP后的80%（43/54）。BC-GP检测使MSSA和VRE菌血症患者的经验性抗生素降级率提高，且缩短了使用最佳抗生素的时间。
