Felsenstein Susanna, Bender Jeffrey M, Sposto Richard, Gentry Matthew, Takemoto Carol, Bard Jennifer Dien
From the Departments of Pediatrics, Division of Infectious Diseases (Drs Felsenstein and Bender).
Preventive Medicine (Dr Sposto).
Arch Pathol Lab Med. 2016 Mar;140(3):267-75. doi: 10.5858/arpa.2015-0119-OA.
Molecular diagnostics allow for rapid identification and detection of resistance markers of bloodstream infection, with a potential for accelerated antimicrobial optimization and improved patient outcomes. Although the impact of rapid diagnosis has been reported, studies in pediatric patients are scarce.
To determine the impact of a molecular blood-culture assay that identifies a broad-spectrum of pathogens and resistance markers in pediatric patients with gram-positive bloodstream infections.
Data on the time to antimicrobial optimization, the length of hospitalization, and the hospital cost following implementation of a rapid assay were prospectively collected and compared with corresponding preimplementation data.
There were 440 episodes from 383 patients included, 221 preimplementation episodes and 219 postimplementation episodes. Overall time to antimicrobial optimization was shortened by 12.5 hours (P = .006), 11.9 hours (P = .005) for bloodstream infections of Staphylococcus aureus specifically. Duration of antibiotics for those with probable blood-culture contamination with coagulase-negative staphylococci was reduced by 36.9 hours (P < .001). Median length of stay for patients admitted to general pediatric units was 1.5 days shorter (P = .04), and median hospital cost was $3757 (P = .03) less after implementation. For S aureus bloodstream infections, median length of stay and hospital cost were decreased by 5.6 days (P = .01) and $13,341 (P = .03), respectively.
Implementation of molecular assay for the detection of gram-positive pathogens and resistance markers significantly reduced time to identification and resistance detection, resulting in accelerated optimization of therapy, shorter length of stay, and decreased health care cost.
分子诊断能够快速鉴定和检测血流感染的耐药标志物，具有加速抗菌药物优化和改善患者预后的潜力。尽管已有关于快速诊断影响的报道，但儿科患者相关研究较少。
确定一种分子血培养检测方法对患有革兰氏阳性血流感染的儿科患者中广谱病原体和耐药标志物的识别影响。
前瞻性收集实施快速检测后抗菌药物优化时间、住院时长和医院成本的数据，并与实施前的相应数据进行比较。
纳入了383例患者的440次发病情况，其中实施前221次发病情况，实施后219次发病情况。总体抗菌药物优化时间缩短了12.5小时（P = 0.006），金黄色葡萄球菌血流感染的优化时间缩短了11.9小时（P = 0.005）。凝固酶阴性葡萄球菌血培养可能污染患者的抗生素使用时长减少了36.9小时（P < 0.001）。普通儿科病房收治患者的中位住院时长缩短了1.5天（P = 0.04），实施后中位医院成本降低了3757美元（P = 0.03）。对于金黄色葡萄球菌血流感染，中位住院时长和医院成本分别减少了5.6天（P = 0.01）和13341美元（P = 0.03）。
实施用于检测革兰氏阳性病原体和耐药标志物的分子检测方法可显著缩短识别和耐药检测时间，从而加速治疗优化进程，缩短住院时长并降低医疗成本。
