加速表型快速血培养检测系统对菌血症患者的临床影响。
Clinical Impact of Accelerate Pheno Rapid Blood Culture Detection System in Bacteremic Patients.
机构信息
Division of Infectious Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Hospital Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
出版信息
Clin Infect Dis. 2021 Dec 6;73(11):e4616-e4626. doi: 10.1093/cid/ciaa649.
BACKGROUND
Accelerate Pheno blood culture detection system (AXDX) provides rapid identification and antimicrobial susceptibility testing results. Limited data exist regarding its clinical impact. Other rapid platforms coupled with antimicrobial stewardship program (ASP) real-time notification (RTN) have shown improved length of stay (LOS) in bacteremia.
METHODS
A single-center, quasi-experimental study of bacteremic inpatients before and after AXDX implementation was conducted comparing clinical outcomes from 1 historical and 2 intervention cohorts (AXDX and AXDX + RTN).
RESULTS
Of 830 bacteremic episodes, 188 of 245 (77%) historical and 308 (155 AXDX, 153 AXDX + RTN) of 585 (65%) intervention episodes were included. Median LOS was shorter with AXDX (6.3 days) and AXDX + RTN (6.7 days) compared to historical (8.1 days) (P = .001). In the AXDX and AXDX + RTN cohorts, achievement of optimal therapy (AOT) was more frequent (93.6% and 95.4%, respectively) and median time to optimal therapy (TTOT) was faster (1.3 days and 1.4 days, respectively) compared to historical (84.6%, P ≤ .001 and 2.4 days, P ≤ .001, respectively). Median antimicrobial days of therapy (DOT) was shorter in both intervention arms compared to historical (6 days each vs 7 days; P = .011). Median LOS benefit during intervention was most pronounced in coagulase-negative Staphylococcus bacteremia (P = .003).
CONCLUSIONS
LOS, AOT, TTOT, and total DOT significantly improved after AXDX implementation. Addition of RTN did not show further improvement over AXDX and an already active ASP. These results suggest that AXDX can be integrated into healthcare systems with an active ASP even without the resources to include RTN.
背景
Accelerate Pheno 血培养检测系统（AXDX）提供快速的鉴定和抗菌药物敏感性测试结果。关于其临床影响的数据有限。其他快速平台与抗菌药物管理计划（ASP）实时通知（RTN）相结合，已显示出在菌血症中住院时间（LOS）的改善。
方法
在 AXDX 实施前后，对住院菌血症患者进行了一项单中心、准实验研究，比较了来自 1 个历史队列和 2 个干预队列（AXDX 和 AXDX+RTN）的临床结果。
结果
在 830 例菌血症发作中，188 例来自 245 例历史病例（77%），308 例来自 585 例干预病例（155 例 AXDX，153 例 AXDX+RTN）。与历史病例（8.1 天）相比，AXDX（6.3 天）和 AXDX+RTN（6.7 天）的 LOS 更短（P=0.001）。在 AXDX 和 AXDX+RTN 队列中，实现最佳治疗（AOT）的频率更高（分别为 93.6%和 95.4%），达到最佳治疗的中位时间（TTOT）更快（分别为 1.3 天和 1.4 天），与历史病例（84.6%，P≤0.001 和 2.4 天，P≤0.001，分别）相比。在干预组中，治疗的中位抗菌药物日数（DOT）均短于历史组（分别为 6 天和 7 天；P=0.011）。干预期间 LOS 获益最显著的是凝固酶阴性葡萄球菌菌血症（P=0.003）。
结论
AXDX 实施后，LOS、AOT、TTOT 和总 DOT 显著改善。添加 RTN 并没有显示出比 AXDX 和已经活跃的 ASP 更进一步的改善。这些结果表明，AXDX 可以与积极的 ASP 一起整合到医疗保健系统中，即使没有资源包括 RTN。
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