Carreno Joseph J, Lomaestro Ben M, Jacobs Apryl L, Meyer Rachel E, Evans Ann, Montero Clemente I
Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York.
Department of Pharmacy, Albany Medical Center Hospital Albany, New York.
Infect Control Hosp Epidemiol. 2016 Aug;37(8):916-923. doi: 10.1017/ice.2016.105. Epub 2016 Jun 9.
OBJECTIVE To evaluate time to clinical response before and after implementation of rapid blood culture identification technologies. DESIGN Before-and-after trial. SETTING Large, tertiary, urban, academic health-sciences center. PATIENTS Patients >18 years old with sepsis and concurrent bacteremia or fungemia were included in the study; patients who were pregnant, had polymicrobial septicemia, or were transferred from an outside hospital were excluded. INTERVENTION Prior to the intervention, polymerase chain reaction was used to identify Staphylococcus species from positive blood cultures, and traditional laboratory techniques were used to identify non-staphylococcal species. After the intervention, matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) assay and FilmArray were also used to identify additional species. During both periods, the antimicrobial stewardship team provided prospective audit and feedback for all patients on antibiotics. RESULTS A total of 219 patients were enrolled in the study: 115 patients prior to the intervention and 104 after the intervention. The median time to clinical response was statistically significantly shorter in the postintervention group than in the preintervention group (2 days vs 4 days, respectively; P=.002). By Cox regression, the implementation of MALDI-TOF and FilmArray was associated with shorter time to clinical response (hazard ratio [HR], 1.360; 95% confidence interval [CI], 1.018-1.816). After controlling for potential confounders, the study group was not independently associated with clinical response (adjusted HR, 1.279; 95% CI, 0.955-1.713). Mortality was numerically, but not statistically significantly, lower in the postintervention group than in the preintervention group (7.6% vs 11.4%; P=.342). CONCLUSIONS In the setting of an existing antimicrobial stewardship program, implementation of MALDI-TOF and FilmArray was associated with improved time to clinical response. Further research is needed to fully describe the effect of antimicrobial stewardship programs on time to clinical response. Infect Control Hosp Epidemiol 2016;37:916-923.
目的 评估快速血培养鉴定技术实施前后的临床反应时间。设计 前后对照试验。地点 大型城市三级学术健康科学中心。患者 年龄>18岁且患有脓毒症并发菌血症或真菌血症的患者纳入研究；排除孕妇、患有多种微生物败血症或从外院转入的患者。干预措施 干预前，采用聚合酶链反应从阳性血培养物中鉴定葡萄球菌属，采用传统实验室技术鉴定非葡萄球菌属。干预后，还使用基质辅助激光解吸电离飞行时间（MALDI-TOF）分析和FilmArray鉴定其他菌种。在两个时期，抗菌药物管理团队对所有患者的抗生素使用提供前瞻性审核和反馈。结果 共219例患者纳入研究：干预前115例，干预后104例。干预后组的临床反应中位时间在统计学上显著短于干预前组（分别为2天和4天；P = 0.002）。通过Cox回归分析，MALDI-TOF和FilmArray的实施与临床反应时间缩短相关（风险比[HR]，1.360；95%置信区间[CI]，1.018 - 1.816）。在控制潜在混杂因素后，研究组与临床反应无独立相关性（校正HR，1.279；95%CI，0.955 - 1.713）。干预后组的死亡率在数值上低于干预前组，但无统计学显著性差异（7.6%对11.4%；P = 0.342）。结论 在现有抗菌药物管理计划的背景下，MALDI-TOF和FilmArray的实施与临床反应时间的改善相关。需要进一步研究以全面描述抗菌药物管理计划对临床反应时间的影响。《感染控制与医院流行病学》2016年；37:916 - 923。
