Environmental Research Laboratory, University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK.
Division of Critical Care, University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK.
Sci Rep. 2020 Feb 20;10(1):3122. doi: 10.1038/s41598-020-60072-9.
Unnecessary antimicrobial treatment promotes the emergence of resistance. Early confirmation that a blood culture is negative could shorten antibiotic courses. The Cognitor Minus test, performed on blood culture samples after 12 hours incubation has a negative predictive value (NPV) of 99.5%. The aim of this study was to determine if earlier confirmation of negative blood culture result would shorten antibiotic treatment. Paired blood cultures were taken in the Critical Care Unit at a teaching hospital. The Cognitor Minus test was performed on one set >12 hours incubation but results kept blind. Clinicians were asked after 24 and 48 hours whether a result excluding bacteraemia or fungaemia would affect decisions to continue or stop antimicrobial treatment. Over 6 months, 125 patients were enrolled. The median time from start of incubation to Cognitor Minus test was 27.1 hours. When compared to 5 day blood culture results from both the control and test samples, Cognitor Minus gave NPVs of 99% and 100% respectively. Test results would have reduced antibiotic treatment in 14% (17/119) of patients at 24 and 48 hours (24% at either time) compared with routine blood culture. The availability of rapid tests to exclude bacteraemia may be of benefit in antimicrobial stewardship.
不必要的抗菌治疗会促进耐药性的出现。早期确认血培养阴性可以缩短抗生素疗程。Cognitor Minus 试验在血液培养物孵育 12 小时后进行，其阴性预测值（NPV）为 99.5%。本研究旨在确定更早地确认阴性血培养结果是否会缩短抗生素治疗时间。在一家教学医院的重症监护病房采集配对的血培养物。Cognitor Minus 试验在一组培养物上进行，孵育时间超过 12 小时，但结果保持盲法。在 24 小时和 48 小时时，临床医生被问及是否排除菌血症或真菌血症的结果会影响继续或停止抗菌治疗的决定。在 6 个月的时间里，共纳入了 125 名患者。从孵育开始到进行 Cognitor Minus 试验的中位数时间为 27.1 小时。与对照组和试验组的 5 天血培养结果相比，Cognitor Minus 的 NPV 分别为 99%和 100%。与常规血培养相比，试验结果可使 14%（17/119）的患者在 24 小时和 48 小时（任何时间的 24%）减少抗生素治疗。快速检测以排除菌血症的可用性可能有助于抗菌药物管理。
