Bunsow Eleonora, Vecchio Marcela González-Del, Sanchez Carlos, Muñoz Patricia, Burillo Almudena, Bouza Emilio
From the Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain (EB, MG-DV, CS, PM, AB, EB); Microbiology Department, School of Medicine, Universidad Complutense de Madrid, Spain (PM, AB, EB); and Ciber de Enfermedades respiratorias, CibeRes, Palma de Mallorca, Spain (PM, AB, EB).
Medicine (Baltimore). 2015 Sep;94(39):e1454. doi: 10.1097/MD.0000000000001454.
Early sepsis attention is a standard of care in many institutions and the role of different specialists is well recognized. However, the impact of a telephone call from a specialist in Clinical Microbiology upon blood cultures request has not been assessed to the best of our knowledge. We performed telephone calls followed by an interview with physicians and nurses in charge of adult patients (> 18 years old) whose blood cultures had just been received in the Microbiology Laboratory in a tertiary hospital. Patients were randomly classified in 2 different groups: group A (telephone call performed) and group B (no telephone call). At the end of the telephonic intervention, recommendations on the use of microbiology and biochemical tests as well as on the management and antibiotic therapy of sepsis were made if required. We included 300 patients. Of those fulfilling standard criteria of sepsis, 30.3% of the nurses and 50% of the physicians immediately recognized it. Advice to optimize the use of biochemical and microbiological tests was provided in 36% of the cases and to improve antimicrobial therapy in 57.6%. The median number of days of antibiotic use in groups A and B were, respectively, 6 days (IQR: 2-12) vs 9 days (IQR: 4-16) P = 0.008 and the median number of prescribed daily doses of antimicrobials (6 [IQR: 3-17] vs 10 [IQR: 5-22] P = 0.016) were lower in group A. We estimate a reduction, only in the use of antibiotic, of 1.8 million Euros per year. A telephone call with management advice, immediately after the arrival of blood cultures in the Microbiology Laboratory improves the recognition of sepsis and the use of diagnostic resources and reduces antimicrobial consumption and expenses.
早期识别脓毒症是许多医疗机构的一项护理标准，不同专科医生的作用也得到了充分认可。然而，据我们所知，临床微生物学专科医生的电话对血培养申请的影响尚未得到评估。我们对一家三级医院微生物实验室刚收到血培养结果的成年患者（>18岁）的主管医生和护士进行了电话随访并随后进行访谈。患者被随机分为两组：A组（进行电话随访）和B组（未进行电话随访）。在电话干预结束时，根据需要就微生物学和生化检测的使用以及脓毒症的管理和抗生素治疗提出了建议。我们纳入了300名患者。在符合脓毒症标准的患者中，30.3%的护士和50%的医生能立即识别出来。36%的病例提供了优化生化和微生物检测使用的建议，57.6%的病例提供了改善抗菌治疗的建议。A组和B组抗生素使用的中位天数分别为6天（四分位间距：2 - 12）和9天（四分位间距：4 - 16），P = 0.008，A组每日开具的抗菌药物剂量中位数（6 [四分位间距：3 - 17] 与10 [四分位间距：5 - 22]，P = 0.016）更低。我们估计每年仅抗生素使用量就能减少180万欧元。在微生物实验室收到血培养结果后立即进行一次提供管理建议的电话随访，可提高对脓毒症的识别和诊断资源的利用，并减少抗菌药物的使用和费用。
