Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
Clin Microbiol Infect. 2017 Feb;23(2):78-85. doi: 10.1016/j.cmi.2016.08.009. Epub 2016 Aug 26.
Rapid identification of pathogens directly from positive blood cultures (BC) in combination with an antimicrobial stewardship programme (ASP) is associated with improved antibiotic treatment and outcomes, but the effect of each individual intervention is less clear. The current study investigated the impact of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) versus conventional identification on antibiotic management in a setting with a well-established ASP and low resistance rates.
In this single-centre open label, controlled clinical trial 425 patients with positive BCs were allocated by weekday during a 1-year period to either MALDI-TOF directly from positive BCs or conventional processing. ASP was identical throughout the study period. The primary outcome was duration of intravenous antimicrobial therapy and was analysed in an intention-to-treat approach.
In all, 368 patients were analysed (MALDI-TOF n = 168; conventional n = 200) with similar baseline characteristics. Mean duration of intravenous antimicrobial therapy (12.9 versus 13.2 days, p 0.9) and length of stay (16.1 versus 17.9 days, p 0.3) were comparable. In the clinically significant bloodstream infection subgroup (n = 242) mean time from Gram-stain to active treatment was significantly shorter (3.7 versus 6.7 h, p 0.003). Admission to the intensive care unit after bloodstream infection onset was less frequent in the MALDI-TOF group (23.1 versus 37.2%, p 0.02).
Rapid identification of contaminated BCs (n = 126) resulted in a shorter duration of intravenous antimicrobial therapy (mean 4.8 versus 7.5 days, p 0.04). Rapid identification using MALDI-TOF directly from positive BCs did not impact on duration of intravenous antimicrobial therapy, but provided fast and reliable microbiological results and may improve treatment quality in the setting of an established ASP.
直接从阳性血培养物（BC）中快速鉴定病原体，并结合抗菌药物管理计划（ASP），可改善抗生素治疗效果和预后，但每种干预措施的效果尚不清楚。本研究调查了基质辅助激光解吸/电离飞行时间质谱（MALDI-TOF）与传统鉴定方法在具有良好建立的 ASP 和低耐药率的环境中对抗生素管理的影响。
在这项为期 1 年的单中心、开放标签、对照临床试验中，根据工作日将 425 名阳性 BC 患者分为 MALDI-TOF 直接从阳性 BC 或常规处理组。整个研究期间 ASP 保持一致。主要结局是静脉内抗菌治疗的持续时间，并采用意向治疗进行分析。
共分析了 368 例患者（MALDI-TOF 组 n=168 例；常规组 n=200 例），两组基线特征相似。静脉内抗菌治疗的平均持续时间（12.9 天 vs. 13.2 天，p=0.9）和住院时间（16.1 天 vs. 17.9 天，p=0.3）无差异。在临床上有意义的血流感染亚组（n=242）中，从革兰氏染色到开始积极治疗的平均时间显著缩短（3.7 小时 vs. 6.7 小时，p=0.003）。血流感染发生后入住重症监护病房的患者在 MALDI-TOF 组较少（23.1% vs. 37.2%，p=0.02）。
快速鉴定污染的 BC（n=126）可缩短静脉内抗菌治疗的持续时间（平均 4.8 天 vs. 7.5 天，p=0.04）。使用 MALDI-TOF 直接从阳性 BC 进行快速鉴定并未影响静脉内抗菌治疗的持续时间，但提供了快速可靠的微生物学结果，并可能在建立 ASP 的情况下提高治疗质量。
