一种结合核酸微阵列检测和直接医生响应的医疗保健改进干预措施，用于管理金黄色葡萄球菌菌血症。
A Healthcare Improvement Intervention Combining Nucleic Acid Microarray Testing With Direct Physician Response for Management of Staphylococcus aureus Bacteremia.
机构信息
Division of Infectious Diseases and International Health, University of Virginia Health System.
Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville.
出版信息
Clin Infect Dis. 2018 Jan 6;66(1):64-71. doi: 10.1093/cid/cix727.
BACKGROUND
Nucleic acid microarray (NAM) testing for detection of Staphylococcus aureus bacteremia (SAB) and S. aureus resistance gene determinants can reduce time to targeted antibiotic administration. Evidence-based management of SAB includes bedside infectious diseases (ID) consultation. As a healthcare improvement initiative at our institution, with the goal of improving management and outcomes for subjects with SAB, we implemented NAM with a process for responding to positive NAM results by directly triggered, mandatory ID consultation.
METHODS
Preintervention, SAB was identified by traditional culture and results passively directed to antibiotic stewardship program (ASP) pharmacists. Postintervention, SAB in adult inpatients was identified by Verigene Gram-Positive Blood Culture test, results paged directly to ID fellow physicians, and consultation initiated immediately. In the new process, ASP assisted with management after the initial consultation. A single-center, retrospective, pre-/postintervention analysis was performed.
RESULTS
One hundred six preintervention and 120 postintervention subjects were assessed. Time to ID consultation after notification of a positive blood culture decreased 26.0 hours (95% confidence interval [CI], 45.1 to 7.1 hours, P < .001) postintervention compared with preintervention. Time to initiation of targeted antibiotic decreased by a mean of 21.2 hours (95% CI, 31.4 to 11.0 hours, P < .001) and time to targeted antibiotics for methicillin-sensitive S. aureus decreased by a mean of 40.7 hours (95% CI, 58.0 to 23.5 hours, P < .001). The intervention was associated with lower in-hospital (13.2% to 5.8%, P = .047) and 30-day (17.9% to 8.3%, P = .025) mortality.
CONCLUSIONS
Compared with an ASP-directed response to traditionally detected SAB, an efficient physician response to NAM was associated with improved care and outcomes for SAB.
背景
核酸微阵列（NAM）检测用于检测金黄色葡萄球菌菌血症（SAB）和金黄色葡萄球菌耐药基因决定因素，可以减少抗生素靶向治疗的时间。SAB 的循证管理包括床边传染病（ID）咨询。作为我们机构的一项医疗保健改进计划，我们的目标是改善 SAB 患者的管理和结果，因此我们实施了 NAM，并制定了针对 NAM 阳性结果的反应流程，直接触发强制性 ID 咨询。
方法
在干预前，SAB 通过传统培养鉴定，并将结果被动传递给抗生素管理项目（ASP）药剂师。在干预后，成人住院患者的 SAB 通过 Verigene 革兰阳性血培养检测鉴定，结果直接传呼 ID 医师，并立即启动咨询。在新流程中，ASP 在初始咨询后协助管理。进行了一项单中心、回顾性、干预前后分析。
结果
共评估了 106 例干预前和 120 例干预后患者。与干预前相比，通知血培养阳性后 ID 咨询的时间减少了 26.0 小时（95%置信区间[CI]，45.1 至 7.1 小时，P<.001）。目标抗生素的起始时间平均减少了 21.2 小时（95%CI，31.4 至 11.0 小时，P<.001），甲氧西林敏感金黄色葡萄球菌的目标抗生素起始时间平均减少了 40.7 小时（95%CI，58.0 至 23.5 小时，P<.001）。该干预措施与住院（13.2%至 5.8%，P=0.047）和 30 天（17.9%至 8.3%，P=0.025）死亡率降低相关。
结论
与传统检测到的 SAB 由 ASP 指导的反应相比，对 NAM 的有效医师反应与 SAB 的治疗和结果改善相关。
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