Murri Rita, Palazzolo Claudia, Giovannenze Francesca, Taccari Francesco, Camici Marta, Spanu Teresa, Posteraro Brunella, Sanguinetti Maurizio, Cauda Roberto, Fantoni Massimo
Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Antibiotics (Basel). 2020 Jul 23;9(8):437. doi: 10.3390/antibiotics9080437.
This study aimed to investigate the clinical and organizational impact of an active re-evaluation (on day 10) of patients on antibiotic treatment diagnosed with bloodstream infections (BSIs). A prospective, single center, pre-post quasi-experimental study was performed. Patients were enrolled at the time of microbial BSI confirmation. In the pre-intervention phase (August 2014-August 2015), clinical status and antibiotic regimen were re-evaluated at day 3. In the intervention phase (January 2016-January 2017), clinical status and antibiotic regimen were re-evaluated at day 3 and day 10. Primary outcomes were rate of optimal therapy, duration of antibiotic therapy, length of hospitalization, and 30-day mortality. A total of 632 patients were enrolled (pre-intervention period, = 303; intervention period, = 329). Average duration of therapy reduced from 18.1 days (standard deviation (SD), 11.4) in the pre-intervention period to 16.8 days (SD, 12.7) in the intervention period ( < 0.001). Similarly, average length of hospitalization decreased from 24.1 days (SD, 20.8) to 20.6 days (SD, 17.7) ( = 0.001). No inter-group difference was found for the rate of 30-day mortality. In patients with BSI, re-evaluation of clinical status and antibiotic regimen at day 3 and 10 after microbiological diagnosis was correlated with a reduction in the duration of antibiotic therapy and hospital stay. The intervention is simple and has a low impact on overall costs.
本研究旨在调查对诊断为血流感染（BSIs）且正在接受抗生素治疗的患者进行积极重新评估（在第10天）的临床和组织影响。进行了一项前瞻性、单中心、前后对照的准实验研究。在微生物学确诊BSI时纳入患者。在干预前阶段（2014年8月至2015年8月），在第3天重新评估临床状况和抗生素治疗方案。在干预阶段（2016年1月至2017年1月），在第3天和第10天重新评估临床状况和抗生素治疗方案。主要结局指标为最佳治疗率、抗生素治疗持续时间、住院时间和30天死亡率。共纳入632例患者（干预前阶段，n = 303；干预阶段，n = 329）。治疗平均持续时间从干预前阶段的18.1天（标准差（SD），11.4）降至干预阶段的16.8天（SD，12.7）（P < 0.001）。同样，平均住院时间从24.1天（SD，20.8）降至20.6天（SD，17.7）（P = 0.001）。30天死亡率在组间未发现差异。在BSI患者中，微生物学诊断后第3天和第10天对临床状况和抗生素治疗方案的重新评估与抗生素治疗持续时间和住院时间的缩短相关。该干预措施简单，对总体成本影响较小。
