优化养老院呼吸道感染治疗：护士主导的聚合酶链反应检测。
Optimizing treatment of respiratory tract infections in nursing homes: Nurse-initiated polymerase chain reaction testing.
机构信息
National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Victorian Infectious Diseases Service, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, Victoria, Australia.
出版信息
Am J Infect Control. 2019 Aug;47(8):911-915. doi: 10.1016/j.ajic.2019.02.001. Epub 2019 Mar 6.
BACKGROUND
Diagnostic testing using polymerase chain reaction (PCR) is infrequently initiated for diagnosis of respiratory tract infections (RTIs) in nursing homes. The objectives of this study were to determine the feasibility of implementing nurse-initiated PCR testing of respiratory specimens in nursing home settings and to compare antibiotic prescribing prior to and during the implementation.
METHODS
This was a pragmatic, historically controlled study in 3 nursing homes (181 total beds) in Melbourne, Australia.
RESULTS
The number of PCR tests of respiratory specimens (over 12 months) increased from 5 to 67 when nurses could initiate the tests. Residents with RTI symptoms had a virus identified by PCR in 50.7% of tests, including 14 positive for influenza. Six outbreaks were identified. When clustering was taken into consideration, incidence rates of antibiotic days of therapy did not change (incidence rate ratio = 0.94, 95% confidence interval, 0.25-3.35, P = .92) despite identification of more viral pathogens.
CONCLUSIONS
In nursing homes, nurse-initiated PCR testing of respiratory specimens is feasible and useful in terms of identifying the cause of many RTIs and outbreaks, and viruses are common in this context. However, the current study suggests the availability of these test results alone does not impact antibiotic prescribing.
背景
在养老院中，很少使用聚合酶链反应（PCR）进行呼吸道感染（RTI）的诊断检测。本研究的目的是确定在养老院环境中实施护士主导的呼吸道标本 PCR 检测的可行性，并比较实施前后的抗生素处方情况。
方法
这是在澳大利亚墨尔本的 3 家养老院（共 181 张床）进行的一项实用的、历史性对照研究。
结果
当护士可以启动检测时，呼吸道标本的 PCR 检测数量（超过 12 个月）从 5 增加到 67。有 RTI 症状的居民中有 50.7%的检测结果通过 PCR 检测到病毒，其中 14 例为流感阳性。发现了 6 起暴发。考虑到聚类因素，抗生素治疗天数的发病率没有变化（发病率比=0.94，95%置信区间，0.25-3.35，P=0.92），尽管鉴定出了更多的病毒病原体。
结论
在养老院中，护士主导的呼吸道标本 PCR 检测是可行的，并且在确定许多 RTI 和暴发的病因方面非常有用，在这种情况下病毒很常见。然而，本研究表明，这些检测结果的可用性本身并不能影响抗生素的处方。
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