Department of Pharmacy Services, Anne Arundel Medical Center, Annapolis, Maryland, USA
Department of Pharmacy, Peninsula Regional Medical Center, Salisbury, Maryland, USA.
Antimicrob Agents Chemother. 2020 Aug 20;64(9). doi: 10.1128/AAC.00578-20.
Bloodstream infections (BSI) are associated with increased morbidity and mortality, especially when caused by Gram-negative or fungal pathogens. The objective of this study was to assess the impact of fast identification-antimicrobial susceptibility testing (ID/AST) with the Accelerate Pheno system (AXDX) from May 2018 to December 2018 on antibiotic therapy and patient outcomes. A pre-post quasiexperimental study of 200 patients (100 pre-AXDX implementation and 100 post-AXDX implementation) was conducted. The primary endpoints measured were time to first antibiotic intervention, time to most targeted antibiotic therapy, and 14-day hospital mortality. Secondary endpoints included hospital and intensive care unit (ICU) length of stay (LOS), antibiotic intensity score at 96 h, and 30-day readmission rates. Of 100 patients with Gram-negative bacteremia or candidemia in each cohort, 84 in the preimplementation group and 89 in the AXDX group met all inclusion criteria. The AXDX group had a decreased time to first antibiotic intervention (26.3 versus 8.0, = 0.003), hours to most targeted therapy (14.4 versus 9, = 0.03), hospital LOS (6 versus 8, = 0.002), and average antibiotic intensity score at 96 h (16 versus 12, = 0.002). Both groups had a comparable 14-day mortality (0% versus 3.6%, = 0.11). In this analysis of patients with Gram-negative bacteremia or candidemia, fast ID/AST implementation was associated with decreased hospital LOS, decreased use of broad-spectrum antibiotics, shortened time to targeted therapy, and an improved utilization of antibiotics within the first 96 h of therapy.
血流感染（BSI）与发病率和死亡率增加有关，尤其是由革兰氏阴性或真菌病原体引起的感染。本研究旨在评估 2018 年 5 月至 2018 年 12 月期间使用 Accelerate Pheno 系统（AXDX）进行快速鉴定-药敏试验（ID/AST）对抗生素治疗和患者预后的影响。这是一项回顾性队列研究，共纳入 200 名患者（AXDX 实施前 100 例，AXDX 实施后 100 例）。主要终点是首次抗生素干预时间、最靶向抗生素治疗时间和 14 天住院死亡率。次要终点包括住院和重症监护病房（ICU）住院时间（LOS）、96 小时抗生素强度评分和 30 天再入院率。在每个队列中，革兰氏阴性菌血症或念珠菌血症患者各有 100 例，其中实施前组 84 例，AXDX 组 89 例符合所有纳入标准。AXDX 组首次抗生素干预时间（26.3 小时比 8.0 小时， = 0.003）、达到最靶向治疗的时间（14.4 小时比 9 小时， = 0.03）、住院 LOS（6 天比 8 天， = 0.002）和 96 小时平均抗生素强度评分（16 分比 12 分， = 0.002）均缩短。两组 14 天死亡率（0%比 3.6%， = 0.11）相似。在本分析中，革兰氏阴性菌血症或念珠菌血症患者中，快速 ID/AST 的实施与住院 LOS 缩短、广谱抗生素使用减少、靶向治疗时间缩短以及治疗前 96 小时内抗生素的使用改善有关。
