Methodist Hospital and Methodist Children's Hospital, 7700 Floyd Curl Drive, San Antonio, TX 78229; Pharmacotherapy Education & Research Center, UT Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229.
The University of Texas at Austin College of Pharmacy, 2409 University Ave., Austin, TX 78712.
Diagn Microbiol Infect Dis. 2020 Sep;98(1):115084. doi: 10.1016/j.diagmicrobio.2020.115084. Epub 2020 May 16.
Rapid diagnostic testing (RDT) combined with an antimicrobial stewardship program (ASP) has shown improved outcomes in bloodstream infections (BSIs). We assessed the impact of RDT, surveillance software, and ASP pharmacist staffing on time to optimal therapy (TOT) in Gram-negative BSIs. Adults with Gram-negative BSIs were included in this retrospective evaluation across 2 study periods. The preimplementation group (n = 121) had longer TOT than the postimplementation group (n = 120) (59.6 ± 36.2 h versus 29.0 ± 24.2 h, P < 0.001). Escalation (51.1 ± 26.4 h versus 16.9 ± 15.7 h, P < 0.001) and de-escalation (63.1 ± 39.5 h versus 39.2 ± 25.6 h, P < 0.01) of therapy were shorter in the postimplementation group. TOT for patients with multidrug-resistant organisms (MDROs) was shorter in the postimplementation group (61.8 ± 37.2 h versus 21.9 ± 18.8 h, P < 0.001). TOT was shorter during fully staffed clinical pharmacist hours (30.6 ± 58.9 h versus 19.7 ± 31.7 h, p = 0.014). Implementation of RDT and surveillance software with an ASP decreased TOT for Gram-negative BSIs, including MDROs.
快速诊断检测 (RDT) 与抗菌药物管理计划 (ASP) 相结合，已显示在血流感染 (BSI) 中改善了结局。我们评估了 RDT、监测软件和 ASP 药师配备对革兰氏阴性菌 BSI 最佳治疗时机 (TOT) 的影响。在两个研究期间，回顾性评估了患有革兰氏阴性菌 BSI 的成年人。实施前组（n=121）的 TOT 长于实施后组（n=120）（59.6±36.2 h 与 29.0±24.2 h，P<0.001）。治疗升级（51.1±26.4 h 与 16.9±15.7 h，P<0.001）和降级（63.1±39.5 h 与 39.2±25.6 h，P<0.01）在实施后组中更短。实施后组中多药耐药菌 (MDRO) 患者的 TOT 更短（61.8±37.2 h 与 21.9±18.8 h，P<0.001）。在临床药师全职工作时间内（30.6±58.9 h 与 19.7±31.7 h，p=0.014），TOT 更短。实施 RDT 和监测软件与 ASP 降低了革兰氏阴性菌 BSI，包括 MDRO 患者的 TOT。
