Vanderbilt University Medical Center, Nashville, TN.
Infect Control Hosp Epidemiol. 2020 Nov;41(11):1285-1291. doi: 10.1017/ice.2020.317. Epub 2020 Sep 3.
To quantify the impact of clinical guidance and rapid respiratory and meningitis/encephalitis multiplex polymerase chain reaction (mPCR) testing on the management of infants.
Before-and-after intervention study.
Tertiary-care children's hospital.
Infants ≤90 days old presenting with fever or hypothermia to the emergency department (ED).
The study spanned 3 periods: period 1, January 1, 2011, through December 31, 2014; period 2, January 1, 2015, through April 30, 2018; and period 3, May 1, 2018, through June 15, 2019. During period 1, no standardized clinical guideline had been established and no rapid pathogen testing was available. During period 2, a clinical guideline was implemented, but no rapid testing was available. During period 3, a guideline was in effect, plus mPCR testing using the BioFire FilmArray respiratory panel 2 (RP 2) and the meningitis encephalitis panel (MEP). Outcomes included antimicrobial and ancillary test utilization, length of stay (LOS), admission rate, 30-day mortality. Outcomes were compared across periods using Kruskal-Wallis and Pearson tests and interrupted time series analysis.
Overall 5,317 patients were included: 2,514 in period 1, 2,082 in period 2, and 721 in period 3. Over the entire study period, we detected reductions in the use of chest radiographs, lumbar punctures, LOS, and median antibiotic duration. After adjusting for temporal trends, we observed that the introduction of the guideline was associated with reductions in ancillary tests and lumbar punctures. Use of mPCR testing with the febrile infant clinical guideline was associated with additional reductions in ancillary testing for all patients and a higher proportion of infants 29-60 days old being managed without antibiotics.
Use of mPCR testing plus a guideline for young infant evaluation in the emergency department was associated with less antimicrobial and ancillary test utilization compared to the use of a guideline alone.
量化临床指南和快速呼吸道及脑膜炎/脑炎多重聚合酶链反应（mPCR）检测对婴儿管理的影响。
干预前后研究。
三级保健儿童医院。
发热或低体温的 90 天以下婴儿就诊于急诊科（ED）。
该研究跨越 3 个时期：第 1 时期，2011 年 1 月 1 日至 2014 年 12 月 31 日；第 2 时期，2015 年 1 月 1 日至 2018 年 4 月 30 日；第 3 时期，2018 年 5 月 1 日至 2019 年 6 月 15 日。第 1 时期，没有制定标准化临床指南，也没有快速病原体检测。第 2 时期，实施了临床指南，但没有快速检测。第 3 时期，实施了指南，同时使用生物火薄膜阵列呼吸道面板 2（RP 2）和脑膜炎脑炎面板（MEP）进行 mPCR 检测。结果包括抗菌药物和辅助检测的使用、住院时间（LOS）、入院率、30 天死亡率。使用 Kruskal-Wallis 和 Pearson 检验和中断时间序列分析比较各时期的结果。
共纳入 5317 例患者：第 1 时期 2514 例，第 2 时期 2082 例，第 3 时期 721 例。在整个研究期间，我们发现胸部 X 线检查、腰椎穿刺、LOS 和中位抗生素持续时间减少。调整时间趋势后，我们观察到指南的引入与辅助检查和腰椎穿刺减少相关。在发热婴儿临床指南下使用 mPCR 检测与所有患者的辅助检测减少以及更多 29-60 天龄婴儿无需使用抗生素的比例增加有关。
与单独使用指南相比，在急诊科使用 mPCR 检测和年轻婴儿评估指南与减少抗菌药物和辅助检测的使用有关。
