Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY.
Albany College of Pharmacy and Health Sciences, Albany, NY.
Am J Health Syst Pharm. 2019 Mar 19;76(7):460-469. doi: 10.1093/ajhp/zxy087.
Antimicrobial stewardship programs (ASPs) can be aided by using rapid diagnostics (RDT). However, there are limited data evaluating the impact of ASPs and RDT on sepsis outcomes in the setting of the new Sepsis-3 guidelines. This study evaluates the impact of a low-resource method for ASPs with RDT on sepsis outcomes.
This was a prospective, quasi-experimental study with a retrospective double pretest. Patients ≥ 18 years old with sepsis and concurrent bacteremia or fungemia were included; patients who were pregnant, had polymicrobial septicemia or who were transferred from an outside hospital were excluded. In the first pretest (O1), polymerase chain reaction was used to identify Staphylococcal species from positive blood cultures, and traditional laboratory techniques were used to identify other species. Matrix-assisted laser desorption ionization time-of-flight mass spectroscopy and FilmArray were implemented in the second pretest (O2), and twice daily blood culture review was implemented in the posttest (O3).
A total of 394 patients (157 in O1, 176 in O2, 61 in O3) were enrolled. Clinical response was 73.2%, 83.5%, and 88.5% in O1, O2, and O3, respectively, p = 0.013. By Cox regression, the O3 was associated with improved time to clinical response (hazard ratio, 1.388; 95% confidence interval, 1.004-1.919) as compared with O1. Mortality, hospital length of stay, and intensive care unit length of stay were unchanged between groups.
Twice-daily blood culture review may be useful for implementing rapid diagnostics within low-resource ASPs. Further research is needed to identify the optimal method of blood culture follow-up within low-resource settings.
抗菌药物管理计划（ASPs）可以通过使用快速诊断检测（RDT）来辅助实施。然而，在新的 Sepsis-3 指南背景下，评估 ASP 与 RDT 对脓毒症结局影响的数据有限。本研究评估了一种利用 RDT 实施低资源 ASP 的方法对脓毒症结局的影响。
这是一项前瞻性、准实验性研究，采用回顾性双预测试。纳入年龄≥18 岁、伴有脓毒症且同时伴有菌血症或真菌血症的患者；排除妊娠、多病原体脓毒症或来自外院转来的患者。在第一次预测试（O1）中，聚合酶链反应用于从阳性血培养物中鉴定葡萄球菌种，传统实验室技术用于鉴定其他种。基质辅助激光解吸电离飞行时间质谱和 FilmArray 用于第二次预测试（O2），并在测试后（O3）实施每日两次的血培养复查。
共纳入 394 例患者（O1 组 157 例，O2 组 176 例，O3 组 61 例）。O1、O2 和 O3 组的临床反应率分别为 73.2%、83.5%和 88.5%，p=0.013。通过 Cox 回归分析，O3 组与 O1 组相比，临床反应时间缩短（风险比，1.388；95%置信区间，1.004-1.919）。各组之间的死亡率、住院时间和重症监护病房入住时间无变化。
每日两次的血培养复查可能有助于在资源有限的 ASP 中实施快速诊断。需要进一步研究以确定在资源有限的环境中进行血培养随访的最佳方法。
