通过使用快速检测改善革兰阳性菌血流感染患者的结局和抗生素管理（IOAS）：Accelerate PhenoTest™ BC 试剂盒的准实验性多中心研究。

Improving outcomes and antibiotic stewardship (IOAS) for patients with Gram-positive bloodstream infections through use of rapid testing: a quasi-experimental multicentre study of the Accelerate PhenoTest™ BC Kit.

机构信息

Accelerate Diagnostics, Inc, Tucson, AZ, USA.

Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

出版信息

J Antimicrob Chemother. 2021 Aug 12;76(9):2453-2463. doi: 10.1093/jac/dkab165.

DOI:10.1093/jac/dkab165

PMID:34021752

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8361360/

Abstract

BACKGROUND

Data from the Improving Outcomes and Antibiotic Stewardship for Patients with Bloodstream Infections: Accelerate PhenoTest™ BC Kit (AXDX) Registry Study were analysed to determine the impact of rapid organism identification and antimicrobial susceptibility testing (AST) for Gram-positive bacteraemia.

PATIENTS AND METHODS

This multicentre, quasi-experimental study evaluated clinical and antimicrobial stewardship metrics following the implementation of AXDX. Data from hospitalized patients with bacteraemia were compared between groups, one that underwent testing on AXDX (post-AXDX) and one that underwent traditional identification and AST (pre-AXDX). An analysis of patients with Gram-positive bacteraemia was performed. The primary outcome was time to optimal therapy (TTOT). Secondary outcomes included time to first antibiotic modification (overall and Gram-positive), duration of unnecessary MRSA coverage, incidence of adverse events, length of stay and mortality.

RESULTS

A total of 219 (109 pre-AXDX, 110 post-AXDX) patients with Gram-positive bacteraemia were included. Median TTOT was 36.3 h (IQR, 16.9-56.7) in the pre-AXDX group and 20.4 h (IQR, 7.5-36.7) in the post-AXDX group (P = 0.01). Compared with pre-AXDX, median time to first antibiotic modification (29.1 versus 15.9 h; P = 0.002), time to first Gram-positive antibiotic modification (33.2 versus 17.2 h; P = 0.003) and median duration of unnecessary MRSA coverage (58.4 versus 29.7 h; P = 0.04) were reduced post-AXDX. A trend towards decreased acute kidney injury (24% versus 13%; P = 0.06) was observed in the post-AXDX group. Groups did not differ in other secondary outcomes.

CONCLUSIONS

Implementation of AXDX testing for patients with Gram-positive bacteraemia shortened the TTOT and reduced unnecessary antibiotic exposure due to faster antibiotic modifications.

摘要

背景

对来自于改善血流感染患者的临床结果和抗生素管理：加速表型检测 BC 试剂盒（AXDX）注册研究的数据进行了分析，以确定革兰阳性菌菌血症中快速鉴定和药敏检测（AST）对其的影响。

患者和方法

这项多中心、准实验研究评估了 AXDX 实施后的临床和抗生素管理指标。比较了接受 AXDX 检测（AXDX 后）和接受传统鉴定和 AST 检测（AXDX 前）的菌血症住院患者的数据。对革兰阳性菌菌血症患者进行了分析。主要结局是最佳治疗时间（TTOT）。次要结局包括首次抗生素调整时间（整体和革兰阳性菌）、不必要的 MRSA 覆盖时间、不良事件发生率、住院时间和死亡率。

结果

共纳入 219 例（AXDX 前 109 例，AXDX 后 110 例）革兰阳性菌菌血症患者。AXDX 前组 TTOT 的中位数为 36.3 小时（IQR，16.9-56.7），AXDX 后组为 20.4 小时（IQR，7.5-36.7）（P=0.01）。与 AXDX 前组相比，AXDX 后组首次抗生素调整时间（29.1 比 15.9 小时；P=0.002）、首次革兰阳性菌抗生素调整时间（33.2 比 17.2 小时；P=0.003）和不必要的 MRSA 覆盖时间中位数（58.4 比 29.7 小时；P=0.04）均有所缩短。AXDX 后组急性肾损伤发生率呈下降趋势（24%比 13%；P=0.06）。两组在其他次要结局上无差异。