Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA.
Department of Clinical Microbiology, Henry Ford Hospital, Detroit, MI, USA.
Diagn Microbiol Infect Dis. 2022 Jan;102(1):115571. doi: 10.1016/j.diagmicrobio.2021.115571. Epub 2021 Oct 11.
Diagnostic stewardship interventions can decrease unnecessary antimicrobial therapy and microbiology laboratory resources and costs. This retrospective cross-sectional study evaluated factors associated with inappropriate initial cerebrospinal fluid (CSF) testing in patients with suspected community-acquired meningitis or encephalitis. In 250 patients, 202 (80.8%) and 48 (19.2%) were suspected meningitis and encephalitis, respectively. 207 (82.8%) patients had inappropriate and 43 (17.2%) appropriate testing. Any inappropriate CSF test was greatest in the immunocompromised (IC) group (n = 54, 91.5%), followed by non-IC (n = 109, 80.1%) and HIV (n = 44, 80%). Ordering performed on the general ward was associated with inappropriate CSF test orders (adjOR 2.81, 95% CI [1.08-7.34]). Laboratory fee costs associated with excessive testing was close to $300,000 per year. A stepwise algorithm defining empiric and add on tests according to CSF parameters and patient characteristics could improve CSF test ordering in patients with suspected meningitis or encephalitis.
诊断管理干预措施可以减少不必要的抗菌治疗和微生物学实验室资源和成本。本回顾性横断面研究评估了与疑似社区获得性脑膜炎或脑炎患者初始脑脊液 (CSF) 检测不当相关的因素。在 250 例患者中，分别有 202 例 (80.8%) 和 48 例 (19.2%) 疑似脑膜炎和脑炎。207 例 (82.8%) 患者的检测结果不适当，43 例 (17.2%) 患者的检测结果适当。在免疫功能低下 (IC) 组 (n = 54，91.5%) 中，任何不适当的 CSF 检测结果最多，其次是非 IC 组 (n = 109，80.1%) 和 HIV 组 (n = 44，80%)。在普通病房进行的检查与不适当的 CSF 检查结果相关 (调整后的 OR 2.81，95%CI [1.08-7.34])。每年与过度检测相关的实验室费用接近 30 万美元。根据 CSF 参数和患者特征制定的经验性和附加性测试逐步算法可以改善疑似脑膜炎或脑炎患者的 CSF 检测结果。
