De Socio Giuseppe V, Belati Alessandra, Paggi Riccardo, D'Arpino Alessandro, Moretti Amedeo, Allegrucci Filippo, Cenci Elio, Francisci Daniela, Mencacci Antonella
Clinic of Infectious Diseases, Perugia General Hospital and University of Perugia, Italy.
Medical Microbiology, Department of Medicine, University of Perugia, Perugia, Italy.
New Microbiol. 2020 Jan;43(1):6-12. Epub 2020 Mar 1.
This study reports our experience with the Accelerate PhenoTM system (ACC) to guide management of patients with sepsis by Gram-negative pathogens. A diagnostic workflow, based on pathogen and resistance genes detection or ACC testing, was applied to 33 patients. Clinical and microbiological data were recorded, and analysis of broad-spectrum agents sparing was performed. Antimicrobial susceptibility results by ACC were available for 28 of 33 patients (84.85%). Among 434 microorganism-antimicrobial combinations, categorical agreement was 97.93%, very major errors 0.23%, major errors 1.15%, and minor errors 0.69%. Time to report (mean ± SD) of ACC results was 27.14±6.90 h from sample collection, significantly shorter (p<0.001, Δ = 19.96 h, 95% CI: 24.71-15.22) than that of the standard method (47.10±11.92 h). A switch from empiric to targeted therapy was observed in 14 of 28 patients (50.0%), duration of empiric therapy was 37.73±19.87 h, with a saving of 5.45 piperacillin/tazobactam and 5.28 carbapenems prescribed daily doses. Considering patients in which de-escalation would have been theoretically feasible, 27.69 prescribed daily doses of piperacillin/tazobactam and 19.08 of carbapenems could had been spared, compared to standard methods. In conclusion, ACC could impact positively on the management of septic patients by Gram-negative pathogens.
本研究报告了我们使用Accelerate PhenoTM系统（ACC）指导革兰氏阴性病原体所致脓毒症患者管理的经验。基于病原体和耐药基因检测或ACC检测的诊断工作流程应用于33例患者。记录临床和微生物学数据，并对广谱抗菌药物的节约情况进行分析。33例患者中有28例（84.85%）可获得ACC的药敏结果。在434种微生物-抗菌药物组合中，类别一致性为97.93%，极重大错误为0.23%，重大错误为1.15%，轻微错误为0.69%。ACC结果的报告时间（均值±标准差）为样本采集后27.14±6.90小时，显著短于标准方法（47.10±11.92小时）（p<0.001，差值=19.96小时，95%可信区间：24.71-15.22）。28例患者中有14例（50.0%）从经验性治疗转为靶向治疗，经验性治疗持续时间为37.73±19.87小时，每日节省哌拉西林/他唑巴坦5.45剂和碳青霉烯类5.28剂。与标准方法相比，在理论上可行降阶梯治疗的患者中，可节省哌拉西林/他唑巴坦每日剂量27.69剂和碳青霉烯类19.08剂。总之，ACC可对革兰氏阴性病原体所致脓毒症患者的管理产生积极影响。
