Rader Theodore S, Stevens Michael P, Bearman Gonzalo
Department of Internal Medicine, Virginia Commonwealth University Health System, 1250 E MARSHALL ST # 980509, Richmond, VA 23298-0019 USA.
Division of Infectious Diseases, Virginia Commonwealth University Health System, Richmond, VA USA.
Curr Infect Dis Rep. 2021;23(4):5. doi: 10.1007/s11908-021-00748-z. Epub 2021 Feb 26.
Syndromic multiplex polymerase chain reaction (mPCR) panels offer the antimicrobial steward a rapid tool for optimizing and de-escalating antimicrobials. In this review, we analyze the role of syndromic mPCR in respiratory, gastrointestinal, and central nervous system infections within the context of antimicrobial stewardship efforts.
For all mPCR syndromic panels, multiple studies analyzed the pre-and-post implementation impact of mPCR on antimicrobial utilization. Prospective studies and trials of respiratory mPCR stewardship interventions, including diagnostic algorithms, educational efforts, co-testing with procalcitonin, and targeted provider feedback currently exist. For gastrointestinal and cerebrospinal fluid mPCR, fewer peer-reviewed reports exist for the use of mPCR in antimicrobial stewardship. These studies demonstrated an inconsistent trend towards decreasing antibiotic use with mPCR. This is further limited by a lack of statistical significance, the absence of controlled, prospective trials, and issues with data generalizability.
Antibiotic overuse may improve when mPCR is coupled with electronic medical record algorithm-based approaches and direct provider feedback by an antimicrobial stewardship professional. mPCR may prove a useful tool for antimicrobial stewardship but future studies are needed to define the best practice for its utilization.
综合征多重聚合酶链反应（mPCR）检测板为抗菌药物管理提供了一种快速工具，用于优化抗菌药物使用并降低用药级别。在本综述中，我们在抗菌药物管理工作的背景下，分析综合征mPCR在呼吸道、胃肠道和中枢神经系统感染中的作用。
对于所有mPCR综合征检测板，多项研究分析了mPCR实施前后对抗菌药物使用的影响。目前存在关于呼吸道mPCR管理干预措施的前瞻性研究和试验，包括诊断算法、教育工作、与降钙素原联合检测以及针对性的提供者反馈。对于胃肠道和脑脊液mPCR，在抗菌药物管理中使用mPCR的同行评审报告较少。这些研究表明，使用mPCR后抗生素使用量呈不一致的下降趋势。这进一步受到缺乏统计学意义、缺乏对照前瞻性试验以及数据可推广性问题的限制。
当mPCR与基于电子病历算法的方法以及抗菌药物管理专业人员的直接提供者反馈相结合时，抗生素过度使用情况可能会得到改善。mPCR可能是抗菌药物管理的有用工具，但需要未来的研究来确定其最佳使用方法。
