在日本一家三级医院中，基质辅助激光解吸电离飞行时间质谱联用抗菌药物管理干预措施对血流感染患者的临床影响。
Clinical impact of matrix-assisted laser desorption ionization-time of flight mass spectrometry combined with antimicrobial stewardship interventions in patients with bloodstream infections in a Japanese tertiary hospital.
作者信息
Niwa Takashi, Yonetamari Jun, Hayama Nozomi, Fujibayashi Ayasa, Ito-Takeichi Syuri, Suzuki Keiko, Ohta Hirotoshi, Niwa Ayumi, Tsuchiya Mayumi, Yamamoto Masayo, Hatakeyama Daijiro, Hayashi Hideki, Obara Michiko, Sugiyama Tadashi, Baba Hisashi, Suzuki Akio, Murakami Nobuo
机构信息
Department of Pharmacy, Gifu University Hospital, Gifu, Japan.
Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan.
出版信息
Int J Clin Pract. 2019 May;73(5):e13332. doi: 10.1111/ijcp.13332. Epub 2019 Mar 21.
BACKGROUND
Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has the potential to permit early organism identification and optimization of antibiotic therapy. However, MALDI-TOF MS combined with antimicrobial stewardship is available at only a limited number of institutions. Here, we evaluated the clinical impact of implementing MALDI-TOF MS combined with antimicrobial stewardship intervention in patients with bloodstream infections.
METHODS
We conducted a single-centre, prospective cohort study to evaluate the clinical impact of implementing MALDI-TOF MS combined with antimicrobial stewardship intervention in patients with bloodstream infections. Processes and clinical outcomes in patients with bloodstream infections were compared before and after implementation of MALDI-TOF MS.
RESULTS
Compared with the conventional identification method, MALDI-TOF MS combined with antimicrobial stewardship intervention significantly decreased the time to organism identification (48.6 ± 46.0 hours vs 78.1 ± 38.9 hours, P < 0.001), effective antimicrobial therapy (12.9 ± 19.0 hours vs 26.2 ± 44.8 hours, P < 0.001) and optimal antimicrobial therapy (53.3 ± 55.0 hours vs 91.7 ± 88.7 hours, P < 0.001. Moreover, the rate of clinical failure (14.0% vs 33.3%, P < 0.001) and incidence of adverse events (7.5% vs 23.9%, P < 0.001) was lower in the MALDI-TOF MS group than in the conventional identification group. A multivariate Cox proportional hazard analysis indicated that implementation of MALDI-TOF MS was a protective factor against clinical failure in patients with bloodstream infections (hazard ratio, 0.61; 95% confidence interval, 0.38-0.99; P = 0.047).
CONCLUSIONS
Implementation of the MALDI-TOF MS combined with antimicrobial stewardship intervention facilitated early optimization of antimicrobial therapy with a remarkable concomitant reduction in clinical failure and adverse events in patients with bloodstream infections.
背景
基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）有潜力实现早期病原体鉴定并优化抗生素治疗。然而，仅有少数机构将MALDI-TOF MS与抗菌药物管理相结合。在此，我们评估了在血流感染患者中实施MALDI-TOF MS联合抗菌药物管理干预的临床影响。
方法
我们进行了一项单中心前瞻性队列研究，以评估在血流感染患者中实施MALDI-TOF MS联合抗菌药物管理干预的临床影响。比较了实施MALDI-TOF MS前后血流感染患者的诊疗过程和临床结局。
结果
与传统鉴定方法相比，MALDI-TOF MS联合抗菌药物管理干预显著缩短了病原体鉴定时间（48.6±46.0小时对78.1±38.9小时，P<0.001）、有效抗菌治疗时间（12.9±19.0小时对26.2±44.8小时，P<0.001）和最佳抗菌治疗时间（53.3±55.0小时对91.7±88.7小时，P<0.001）。此外，MALDI-TOF MS组的临床失败率（14.0%对33.3%，P<0.001）和不良事件发生率（7.5%对23.9%，P<0.001）低于传统鉴定组。多因素Cox比例风险分析表明，实施MALDI-TOF MS是血流感染患者临床失败的保护因素（风险比，0.61；95%置信区间，0.38 - 0.99；P = 0.047）。
结论
实施MALDI-TOF MS联合抗菌药物管理干预有助于早期优化抗菌治疗，同时显著降低血流感染患者的临床失败率和不良事件发生率。
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