Department of Medicine, Yale School of Medicine, New Haven, CT.
Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT.
Diagn Microbiol Infect Dis. 2021 Jan;99(1):115219. doi: 10.1016/j.diagmicrobio.2020.115219. Epub 2020 Sep 22.
Septicemia from bloodstream infections (BSI) is the second largest cause of inpatient mortality and the single most expensive condition for US hospitals to manage. There has been an explosive development of commercial diagnostic systems to accelerate the identification and antimicrobial susceptibility testing (AST) of causative pathogens. Despite adoption of advanced technologies like matrix-assisted laser desorption imaging-time-of-flight mass spectrometry and multiplex polymerase chain reaction for rapid identification, clinical impact has been variable, in part due to the persistent need for conventional AST as well as prescriber understanding of these rapidly evolving platforms. Newer technologies are expanding on rapid detection of genotypic determinants of resistance, but only recently has rapid phenotypic AST been available. Yet, improved outcomes with rapid diagnostic platforms are still most evident in conjunction with active antimicrobial stewardship. This review will outline key advancements in rapid diagnostics for BSI and the role of antimicrobial stewardship in this new era.
败血症是由血流感染（BSI）引起的，是导致住院患者死亡的第二大主要原因，也是美国医院管理成本最高的单一病症。商业诊断系统得到了迅猛发展，旨在加快确定致病病原体并进行药敏试验（AST）。尽管采用了基质辅助激光解吸电离飞行时间质谱和多重聚合酶链反应等先进技术进行快速鉴定，但临床效果参差不齐，部分原因是仍需要进行常规 AST，以及临床医生对这些快速发展的技术平台的了解。新技术在快速检测耐药基因决定因素方面有了扩展，但直到最近才出现了快速表型 AST。然而，与积极的抗菌药物管理相结合，快速诊断平台在改善预后方面的效果才最为明显。本综述将概述血流感染快速诊断方面的重要进展，以及抗菌药物管理在这一新时代的作用。
