Dryden Matthew, Sitjar Agnes, Gunning Zoe, Lewis Sophie, Healey Richard, Satchithananthan Praneeth, Parker Natalie, Keyser Taryn, Saeed Kordo, Bennett Helen V
Hampshire Hospitals NHS Foundation Trust, Winchester, UK.
School of Medicine, University of Southampton, Southampton, UK.
Int J Pharm Pract. 2018 Jun;26(3):267-272. doi: 10.1111/ijpp.12393. Epub 2017 Aug 18.
Antimicrobial review is an important part of antimicrobial stewardship. A novel enzyme template generation and amplification technique (ETGA), the Cognitor Minus (Momentum Bioscience, Long Hanborough, UK) test, has a 99.5% negative predictive value for bacteraemia and fungaemia. This observational study asked two questions: (1) Does a negative ETGA, indicating no bacteraemia or fungaemia, aid antimicrobial review within 48 h of admission; (2) In this real-life clinical setting, does a negative ETGA mean no bacteraemia or fungaemia?
Consecutive blood cultures in patients with clinical infection were tested by ETGA. Negative results indicating an absence of bacteraemia or fungaemia were reviewed by the clinical infection team. Antibiotics were reviewed in these patients, and the role of the ETGA result in antibiotic change was recorded. Patients were followed up for a week.
A total of 197 of 246 samples gave a negative result by ETGA. This led to a positive stewardship outcome (antimicrobials changed) in 145 (73.6%) and negative stewardship outcome (empirical antimicrobials continued) in 47 (23.9%). Of the positive stewardship outcomes, the ETGA result supported the decision not to start antimicrobials in 21 (10.7%) patients, to stop antimicrobials in 21 (10.7%), to switch from IV to oral antimicrobials in 103 (52.2%) or to discharge or leave the patient at home in 58 cases (29.4%).
Enzyme template generation and amplification supports antimicrobial stewardship decisions and may have cost advantages in reducing unnecessary empirical antibiotics and antifungal agents and in discharging patients from hospital earlier. ETGA result was consistent with blood culture findings and gave an earlier negative result.
抗菌药物评估是抗菌药物管理的重要组成部分。一种新型酶模板生成与扩增技术（ETGA），即Cognitor Minus（动力生物科学公司，英国朗汉伯勒）检测，对菌血症和真菌血症的阴性预测值为99.5%。这项观察性研究提出了两个问题：（1）ETGA结果为阴性，表明不存在菌血症或真菌血症，这是否有助于在入院48小时内进行抗菌药物评估？（2）在这种实际临床环境中，ETGA结果为阴性是否意味着不存在菌血症或真菌血症？
对临床感染患者的连续血培养样本进行ETGA检测。临床感染团队对表明不存在菌血症或真菌血症的阴性结果进行评估。对这些患者的抗生素使用情况进行评估，并记录ETGA结果在抗生素调整中的作用。对患者进行为期一周的随访。
246份样本中共有197份ETGA检测结果为阴性。这导致145例（73.6%）出现了积极的管理结果（抗菌药物调整），47例（23.9%）出现了消极的管理结果（继续使用经验性抗菌药物）。在积极的管理结果中，ETGA结果支持了21例（10.7%）患者不开始使用抗菌药物、21例（10.7%）患者停止使用抗菌药物、103例（52.2%）患者从静脉给药改为口服给药，或58例（29.4%）患者出院或居家的决定。
酶模板生成与扩增技术有助于抗菌药物管理决策，在减少不必要的经验性抗生素和抗真菌药物使用以及使患者更早出院方面可能具有成本优势。ETGA结果与血培养结果一致，且给出阴性结果的时间更早。
