Wenzler Eric, Timbrook Tristan T, Wong Jordan R, Hurst John M, MacVane Shawn H
College of Pharmacy, University of Illinois at Chicago, Chicago, IL.
Department of Pharmacy, University of Utah, Salt Lake City, UT.
Am J Health Syst Pharm. 2018 Aug 15;75(16):1191-1202. doi: 10.2146/ajhp170604. Epub 2018 Jul 3.
The implementation and optimization of molecular rapid diagnostic tests (mRDTs) as an antimicrobial stewardship intervention for patients with bloodstream infections (BSIs) are reviewed.
All U.S. acute care hospitals accredited by the Joint Commission are required to implement an antimicrobial stewardship program (ASP). Of the many interventions available to ASPs, mRDTs have demonstrated consistent, meaningful results on antimicrobial optimization and patient outcomes. Even among infectious diseases and antimicrobial stewardship-trained pharmacists, significant knowledge and familiarity gaps exist regarding available mRDTs and how best to implement and optimize them. Given the paucity of infectious diseases and/or antimicrobial stewardship-trained pharmacists, the mandates for establishing ASPs will require non-infectious diseases/antimicrobial stewardship-trained pharmacists to implement stewardship interventions, which may include mRDTs, within their institution. Optimization of mRDTs requires adequate diagnostic stewardship, specifically evaluating how mRDT implementation may decrease costs and assist in meeting antimicrobial stewardship regulatory requirements. Knowledge of how these technologies will augment existing microbiology and antimicrobial stewardship workflow is essential. Finally, selecting the right mRDT necessitates familiarity with the instrument's capabilities and with the institutional antibiogram.
mRDTs have demonstrated the ability to be one of the most powerful antimicrobial stewardship interventions. Pharmacists required to implement an ASP in their institution should consider mRDTs as standard of care for patients with BSIs.
综述分子快速诊断检测（mRDTs）作为血流感染（BSIs）患者抗菌药物管理干预措施的实施与优化。
所有经联合委员会认证的美国急性护理医院都必须实施抗菌药物管理计划（ASP）。在ASP可用的众多干预措施中，mRDTs已在抗菌药物优化和患者预后方面展现出持续且有意义的结果。即使在接受过传染病和抗菌药物管理培训的药剂师中，对于可用的mRDTs以及如何最佳实施和优化它们，也存在显著的知识和熟悉程度差距。鉴于传染病和/或抗菌药物管理培训的药剂师数量稀少，建立ASP的要求将需要非传染病/抗菌药物管理培训的药剂师在其机构内实施管理干预措施，其中可能包括mRDTs。mRDTs的优化需要适当的诊断管理，特别是评估mRDTs的实施如何降低成本并有助于满足抗菌药物管理监管要求。了解这些技术如何增强现有的微生物学和抗菌药物管理工作流程至关重要。最后，选择合适的mRDT需要熟悉仪器的功能和机构抗菌谱。
mRDTs已证明有能力成为最有效的抗菌药物管理干预措施之一。在其机构中需要实施ASP的药剂师应将mRDTs视为BSIs患者的标准治疗方法。
