Kim Jeong-Han, Kim Taek Soo, Song Sang Hoon, Choi Jungil, Han Sangkwon, Kim Dong Young, Kwon Sunghoon, Lee Eunyoung, Song Kyoung-Ho, Choe Pyeong Gyun, Bang Ji Hwan, Kim Eu Suk, Park Sang Won, Kim Hong Bin, Kim Nam Joong, Park Wan Beom, Oh Myoung-Don
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Med Microbiol. 2018 Mar;67(3):325-331. doi: 10.1099/jmm.0.000678. Epub 2018 Jan 12.
The direct rapid antibiotic susceptibility test (dRAST), based on analysing changes in bacterial micro-colonies under antibiotic conditions, detects antibiotic resistance within 6 h of direct smear examination results. This study aimed to assess the accuracy of dRAST and evaluate its potential usefulness for improving selection of appropriate antibiotic in real clinical practice settings.
We evaluated the accuracy of dRAST by comparing the antibiotic treatments that should have been administered based on dRAST results and the broth microdilution (BMD) test and its potential usefulness via simulation.
For 49/52 (94.2 %) patients with Gram-positive bacteraemia and 66/67 (98.5 %) patients with Gram-negative bacteraemia, antibiotics indicated by dRAST results were the same as those indicated by the BMD test. Among 34 patients with ineffective and suboptimal treatment, 19 (55.9 %) of patients could have received optimal treatment 1 to 2 days earlier with dRAST results. Among 33 patients given unnecessary broad-spectrum antibiotics, 1 to 2 days earlier de-escalation could have been possible for 27 (81.8 %) patients based on dRAST results.
The introduction of dRAST could increase the use of optimal antibiotics and reduce unnecessary broad-spectrum antibiotic use in the early period of bacteraemia.
直接快速抗生素敏感性试验（dRAST）基于分析抗生素作用下细菌微菌落的变化，能在直接涂片检查结果得出后6小时内检测出抗生素耐药性。本研究旨在评估dRAST的准确性，并评估其在实际临床实践中对改善合适抗生素选择的潜在效用。
我们通过比较基于dRAST结果应给予的抗生素治疗与肉汤微量稀释（BMD）试验，并通过模拟评估其潜在效用，来评估dRAST的准确性。
对于49/52（94.2%）例革兰氏阳性菌血症患者和66/67（98.5%）例革兰氏阴性菌血症患者，dRAST结果指示的抗生素与BMD试验指示的相同。在34例治疗无效和欠佳的患者中，19例（55.9%）患者若根据dRAST结果本可在1至2天前接受最佳治疗。在33例使用了不必要的广谱抗生素的患者中，根据dRAST结果，27例（81.8%）患者本可在1至2天前实现降阶梯治疗。
引入dRAST可增加最佳抗生素的使用，并减少菌血症早期不必要的广谱抗生素使用。
