Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
Antibiotic Stewardship Team, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
J Antimicrob Chemother. 2021 Apr 13;76(5):1332-1338. doi: 10.1093/jac/dkab026.
The emergence of antibiotic-resistant species calls for fast and reliable phenotypic susceptibility testing to adapt clinical management as fast as possible.
We assessed the real-life performance of EUCAST rapid antimicrobial susceptibility testing (RAST) and analysed its impact on patient management.
RAST was performed on clinical blood cultures containing Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa or Acinetobacter baumannii complex. Categorical agreement with VITEK2 was analysed. A pre-post quasi-experimental observational study was designed to compare antibiotic treatment in sepsis patients in the RAST patient group (n = 51) and a historical control cohort (n = 54).
In total, 436 isolates, corresponding to 2314 disc diameters, were measured; 18.4% of these measurements were in the area of technical uncertainty. For the 81.6% categorical results, which could be compared, 94.7% were in agreement, whereas 5.3% of the results were not. In the RAST group, optimal therapy was initiated on the same day as blood culture positivity, while this was the case in the historical group after 24 h. In six cases, RAST allowed for rapid antibiotic escalation. The 30 day mortality rate was lower in the RAST group, although this was not statistically significant.
RAST provides a reliable tool to improve clinical management of sepsis patients by providing rapid phenotypic susceptibility data. While not necessarily being an instrument for de-escalation, especially in areas of low prevalence, early detection allows for timely coverage of resistant isolates. Thus, RAST significantly adds to successful antibiotic stewardship programmes.
抗生素耐药性的出现要求快速可靠的表型药敏试验，以便尽快适应临床管理。
评估 EUCAST 快速抗菌药敏试验（RAST）的实际性能，并分析其对患者管理的影响。
对含有大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌或鲍曼不动杆菌复合体的临床血培养物进行 RAST。分析与 VITEK2 的分类一致性。设计了一项前后准实验性观察研究，比较 RAST 患者组（n=51）和历史对照组（n=54）中脓毒症患者的抗生素治疗。
共测量了 436 株，相当于 2314 个药敏纸片直径，其中 18.4%的测量值处于技术不确定区域。对于可比较的 81.6%分类结果，94.7%是一致的，而 5.3%的结果不一致。在 RAST 组中，最佳治疗方案在血培养阳性的当天开始，而在历史组中则在 24 小时后开始。在 6 例中，RAST 允许快速升级抗生素。尽管在统计学上没有显著意义，但 RAST 组的 30 天死亡率较低。
RAST 通过提供快速的表型药敏数据，为改善脓毒症患者的临床管理提供了可靠的工具。虽然在耐药率较低的地区不一定是降级的工具，但早期检测可以及时覆盖耐药株。因此，RAST 显著增加了成功的抗生素管理计划。
