Heyerly Angel, Jones Ron, Bokhart Gordon, Shoaff Mary, Fisher Douglas
Hosp Pharm. 2016 Nov;51(10):815-822. doi: 10.1310/hpj5110-815.
Rapid identification of gram-positive bacteria and resistance determinants from blood cultures can reduce the time to optimal antibiotic therapy. This study evaluates the use of technology to rapidly identify gram-positive bacteria in combination with a pharmacist-directed antimicrobial stewardship protocol in a tertiary-care facility. Rapid diagnostic testing was performed on gram-positive blood cultures. Pharmacists were instructed to notify prescribers of results and recommend appropriate antimicrobial therapy based on targeted treatment chart. The primary outcomes were mean time to optimal antibiotic therapy, mean time antibiotics were avoided before traditional culture results, and percent of patients with time to optimal antibiotic therapy reached in less than or equal to 2 hours. Inclusion criteria were met for 297 patients. Mean time to identify bacteria was 26.8 hours with nucleic acid assay versus 75.3 hours with traditional culture (difference = 48.5 hours, < .0001). The rapid identification of gram-positive bacteria combined with accepted pharmacist intervention improved time to optimal antibiotic therapy (8.4 vs 15.4 hours, = .0095). When contaminants were identified, antibiotics were avoided for 39.5 hours before traditional culture with pharmacist intervention versus 37.2 hours ( > .05). Antibiotic change occurred in less than or equal to 2 hours in more patients in the pharmacist intervention group (28% vs 10.5%, = .0002). Rapid identification combined with pharmacist intervention significantly improved time to optimal antibiotic therapy and significantly increased the number of patients receiving optimal antibiotic therapy in less than or equal to 2 hours over rapid identification alone. A pharmacist-directed protocol combined with rapid identification enhanced antimicrobial stewardship.
从血培养物中快速鉴定革兰氏阳性菌及其耐药决定因素可缩短开始最佳抗生素治疗的时间。本研究评估了在一家三级医疗机构中，使用相关技术快速鉴定革兰氏阳性菌并结合药剂师主导的抗菌药物管理方案的效果。对革兰氏阳性血培养物进行了快速诊断检测。指导药剂师将检测结果告知开处方者，并根据针对性治疗图表推荐合适的抗菌治疗方案。主要结局指标包括开始最佳抗生素治疗的平均时间、在传统培养结果出来之前避免使用抗生素的平均时间，以及在2小时内或更短时间内开始最佳抗生素治疗的患者百分比。297例患者符合纳入标准。核酸检测鉴定细菌的平均时间为26.8小时，而传统培养为75.3小时（差异 = 48.5小时，P <.0001）。革兰氏阳性菌的快速鉴定与公认的药剂师干预相结合，改善了开始最佳抗生素治疗的时间（8.4小时对15.4小时，P =.0095）。当鉴定出污染物时，在药剂师干预下，传统培养结果出来之前可避免使用抗生素39.5小时，而未干预时为37.2小时（P >.05）。药剂师干预组中更多患者在2小时内或更短时间内更换了抗生素（28%对10.5%，P =.0002）。与单纯快速鉴定相比，快速鉴定与药剂师干预相结合显著改善了开始最佳抗生素治疗的时间，并显著增加了在2小时内或更短时间内接受最佳抗生素治疗的患者数量。药剂师主导的方案与快速鉴定相结合增强了抗菌药物管理。
