Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium.
Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium.
Eur J Clin Microbiol Infect Dis. 2018 Dec;37(12):2253-2260. doi: 10.1007/s10096-018-3366-8. Epub 2018 Sep 5.
For patients with bloodstream infections, rapid initiation of the appropriate antimicrobial therapy is essential in reducing mortality and morbidity. New developments and automation in clinical microbiology labs speed up the identification and susceptibility results but are expensive. To gain insight in the added value of the new workflows, we simulated the possible impact of rapid identification and susceptibility tests on a real-life cohort of 158 positive blood culture episodes. Our routine workflow was theoretically challenged against two new workflows, one based on rapid identification with MALDI-TOF MS and one based on molecular testing. First, we observed an important role of the rapid communication of the gram stain results, as about one third of patients needed an adaptation of the antimicrobial therapy based on these results. Antibiotic adaptation based on the microorganism identification was necessary in 10% and in another 25% of cases after the availability of the susceptibility results. The added value of the newer workflow methods lies mainly in the field of the rapid identification and was rather limited in our cohort. In conclusion, for optimizing the blood culture workflow, each microbiology lab should critically scan its own workflow and know its own blood culture epidemiology, before investing in expensive or time-consuming processes.
对于血流感染患者，快速启动适当的抗菌治疗对于降低死亡率和发病率至关重要。临床微生物学实验室的新进展和自动化可以加快鉴定和药敏结果，但成本高昂。为了深入了解新工作流程的附加值，我们模拟了快速鉴定和药敏试验对 158 例阳性血培养物实际队列的可能影响。我们的常规工作流程理论上受到两种新工作流程的挑战，一种基于 MALDI-TOF MS 的快速鉴定，另一种基于分子检测。首先，我们观察到革兰氏染色结果快速沟通的重要作用，因为大约三分之一的患者需要根据这些结果调整抗菌治疗。在获得药敏结果后，10%和另外 25%的患者需要根据微生物鉴定结果调整抗生素。更新的工作流程方法的附加值主要在于快速鉴定领域，在我们的队列中相对有限。总之，为了优化血培养工作流程，每个微生物学实验室都应在投资昂贵或耗时的流程之前，批判性地检查其自身的工作流程并了解其自身的血培养流行病学。
