D'Onofrio Valentino, Salimans Lene, Bedenić Branka, Cartuyvels Reinoud, Barišić Ivan, Gyssens Inge C
Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium.
Open Forum Infect Dis. 2020 Aug 13;7(10):ofaa352. doi: 10.1093/ofid/ofaa352. eCollection 2020 Oct.
Fast microbiological diagnostics (MDx) are needed to ensure early targeted antimicrobial treatment in sepsis. This systematic review focuses on the impact on antimicrobial management and patient outcomes of MDx for pathogen and resistance gene identification compared with blood cultures. PubMed was searched for clinical studies using either whole blood directly or after short-term incubation. Twenty-five articles were retrieved describing the outcomes of 8 different MDx. Three interventional studies showed a significant increase in appropriateness of antimicrobial therapy and a nonsignificant change in time to appropriate therapy. Impact on mortality was conflicting. Length of stay was significantly lower in 2 studies. A significant decrease in antimicrobial cost was demonstrated in 6 studies. The limitations of this systematic review include the low number and observed heterogeneity of clinical studies. In conclusion, potential benefits of MDx regarding antimicrobial management and some patient outcomes were reported. More rigorous intervention studies are needed focusing on the direct benefits for patients.
为确保脓毒症患者能尽早接受有针对性的抗菌治疗，快速微生物诊断（MDx）至关重要。本系统评价聚焦于与血培养相比，用于病原体和耐药基因鉴定的MDx对抗菌药物管理及患者预后的影响。通过在PubMed中检索直接使用全血或短期孵育后进行的临床研究。共检索到25篇描述8种不同MDx结果的文章。三项干预性研究显示抗菌治疗的恰当性显著提高，而达到恰当治疗的时间无显著变化。对死亡率的影响存在矛盾。两项研究中住院时间显著缩短。六项研究表明抗菌药物成本显著降低。本系统评价的局限性包括临床研究数量较少且观察到存在异质性。总之，已报道了MDx在抗菌药物管理及一些患者预后方面的潜在益处。需要开展更严格的干预性研究，重点关注对患者的直接益处。
