St. Elizabeth's Medical Center, Brighton, MA, USA; Clinical Pharmacy Department, Umm Al-Qura University, Makkah, Saudi Arabia.
Pharmacy Practice Department, King Abdulaziz University, Jeddah, Saudi Arabia.
J Hosp Infect. 2020 Nov;106(3):436-446. doi: 10.1016/j.jhin.2020.09.010. Epub 2020 Sep 11.
Rapid diagnostic testing (RDT) has been shown to be associated with improved clinical outcomes.
To evaluate the clinical outcomes of using RDT paired with well-defined pharmacist-directed antimicrobial stewardship programme (ASP) guidance to achieve targeted treatment in patients with bacteraemia.
In this quasi-study, a retrospective (pre-intervention) phase was compared with a prospective (post-intervention) phase. Adult patients with positive blood cultures identified using the BacT/ALERT system were included. Bacterial identification and susceptibility were provided by VITEK 2. During the post-intervention phase, Verigene ASP guidance was developed to optimize antibiotic selection. Pharmacists received the results from the microbiology laboratory, evaluated the appropriateness of current therapy (if any), and communicated the recommended antimicrobial therapy to the treating physician accordingly.
The cohort consisted of 164 patients in the pre-intervention group and 148 patients in the post-intervention group. When comparing the post-intervention period with the pre-intervention period, the median time to culture identification was 22 vs 96 h (P<0.0001), median time to targeted antibiotics was 2 vs 22 h (P<0.0001), median time for antibiotic de-escalation was 12.2 vs 27 h (P<0.0001), and median time to escalation was 1.3 vs 24 h (P<0.003), respectively. In-hospital mortality and 30-day re-admission were significantly lower in the post-intervention group (P<0.003 and 0.034, respectively). Length of hospital stay was significantly shorter in the post-intervention group (6.5 vs 8 days; P=0.03).
Rapid identification of bacteraemia combined with a pharmacist's recommendation as an ASP initiative significantly improved time to optimal therapy, and may have decreased the risk of mortality and re-admission.
快速诊断检测（RDT）已被证明与改善临床结果相关。
评估在菌血症患者中使用 RDT 与明确的药师指导抗菌药物管理计划（ASP）指导相结合以实现靶向治疗的临床结果。
在这项准研究中，回顾性（干预前）阶段与前瞻性（干预后）阶段进行了比较。使用 BacT/ALERT 系统鉴定的阳性血培养的成年患者包括在内。细菌鉴定和药敏性由 VITEK 2 提供。在干预后阶段，开发了 Verigene ASP 指南以优化抗生素选择。药剂师收到微生物学实验室的结果，评估当前治疗的适宜性（如有），并相应地将推荐的抗菌治疗方案传达给主治医生。
干预前组包括 164 例患者，干预后组包括 148 例患者。与干预前相比，干预后期间的中位培养鉴定时间为 22 与 96 小时（P<0.0001），中位靶向抗生素时间为 2 与 22 小时（P<0.0001），中位抗生素降阶梯时间为 12.2 与 27 小时（P<0.0001），中位升级时间为 1.3 与 24 小时（P<0.003）。干预后组的院内死亡率和 30 天再入院率显著降低（P<0.003 和 0.034）。干预后组的住院时间明显缩短（6.5 与 8 天；P=0.03）。
快速鉴定菌血症结合药师作为 ASP 计划的建议显著改善了最佳治疗的时间，并且可能降低了死亡率和再入院的风险。
