Rhode Island Infectious Diseases Research Program, Providence Veterans Affairs Medical Center.
College of Pharmacy, University of Rhode Island, Kingston.
Clin Infect Dis. 2017 Jan 1;64(1):15-23. doi: 10.1093/cid/ciw649. Epub 2016 Sep 26.
Previous reports on molecular rapid diagnostic testing (mRDT) do not consistently demonstrate improved clinical outcomes in bloodstream infections (BSIs). This meta-analysis seeks to evaluate the impact of mRDT in improving clinical outcomes in BSIs.
We searched PubMed, CINAHL, Web of Science, and EMBASE through May 2016 for BSI studies comparing clinical outcomes between mRDT and conventional microbiology methods.
Thirty-one studies were included with 5920 patients. The mortality risk was significantly lower with mRDT than with conventional microbiology methods (odds ratio [OR], 0.66; 95% confidence interval [CI], .54-.80), yielding a number needed to treat of 20. The mortality risk was slightly lower with mRDT in studies with antimicrobial stewardship programs (ASPs) (OR, 0.64; 95% CI, .51-.79), and non-ASP studies failed to demonstrate a significant decrease in mortality risk (0.72; .46-1.12). Significant decreases in mortality risk were observed with both gram-positive (OR, 0.73; 95% CI, .55-.97) and gram-negative organisms (0.51; .33-.78) but not yeast (0.90; .49-1.67). Time to effective therapy decreased by a weighted mean difference of -5.03 hours (95% CI, -8.60 to -1.45 hours), and length of stay decreased by -2.48 days (-3.90 to -1.06 days).
For BSIs, mRDT was associated with significant decreases in mortality risk in the presence of a ASP, but not in its absence. mRDT also decreased the time to effective therapy and the length of stay. mRDT should be considered as part of the standard of care in patients with BSIs.
先前关于分子快速诊断检测（mRDT）的报告并未一致证明其在血流感染（BSI）中改善临床结局。本荟萃分析旨在评估 mRDT 在改善 BSI 临床结局方面的影响。
我们通过 2016 年 5 月检索了 PubMed、CINAHL、Web of Science 和 EMBASE，以比较 mRDT 与传统微生物学方法在 BSI 研究中比较临床结局的研究。
共纳入 31 项研究，共 5920 例患者。与传统微生物学方法相比，mRDT 的死亡率风险显著降低（优势比 [OR]，0.66；95%置信区间 [CI]，0.54-0.80），治疗需要的数量为 20。在有抗菌药物管理计划（ASPs）的研究中，mRDT 的死亡率风险略低（OR，0.64；95%CI，0.51-0.79），而无 ASP 研究未能证明死亡率风险显著降低（0.72；0.46-1.12）。革兰氏阳性菌（OR，0.73；95%CI，0.55-0.97）和革兰氏阴性菌（0.51；0.33-0.78）显著降低死亡率风险，但酵母（0.90；0.49-1.67）没有。有效治疗的时间平均减少了 -5.03 小时（95%CI，-8.60 至 -1.45 小时），住院时间减少了 -2.48 天（-3.90 至 -1.06 天）。
对于 BSI，在有 ASP 的情况下，mRDT 与死亡率风险的显著降低相关，但在没有 ASP 的情况下则没有。mRDT 还缩短了有效治疗的时间和住院时间。mRDT 应被视为 BSI 患者标准治疗的一部分。
