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药师参与对革兰氏阴性血培养鉴定组合在抗菌药物使用方面效用的影响。

Impact of Pharmacist Involvement on the Utility of a Gram-Negative Blood Culture Identification Panel on Antimicrobial Usage.

作者信息

Bowman Caitlin, Holloway Melissa, Scott Lisa, Russell Carmen, Lott Sonia, Amin Raid

机构信息

West Florida Healthcare, Pensacola, FL, USA.

University of West Florida, Pensacola, FL, USA.

出版信息

J Pharm Technol. 2021 Dec;37(6):304-309. doi: 10.1177/87551225211046627. Epub 2021 Sep 18.

Abstract

A rapid molecular diagnostic test (MDT) is a test used to identify several different species of gram-negative bacteria and their genetic resistance markers. However, the impact of rapid MDT has not been established when combined with pharmacist involvement. To determine the impact of pharmacy involvement on patient outcomes when using rapid MDT. The primary outcome is the time from gram stain result to the first dose of the targeted antibiotic. This is a single-center, quasi-experimental, 1-group pretest-posttest design study of patients with gram-negative bacteremia in a community hospital. Hospitalized patients 18 years or older were included if they had a gram-negative blood culture. Patients were excluded if they were discharged or expired prior to culture results. Outcomes were compared between patients prior to and after implementation of the automated MDT. This research was determined to be exempt from institutional review board oversight consistent with West Florida Healthcare and in accordance with institutional policy. The use of rapid MDT combined with pharmacist intervention resulted in a statistically significant decrease in the time to targeted antibiotic therapy (pre-intervention group, n = 77, 44.8 ± 17.8 hours versus post-intervention group, n= 80, 4.4 ± 5.8 hours; ≤.001). There was no significant difference found between secondary outcomes. Limitations included small sample size as well as inconsistent documentation. The use of rapid MDT combined with pharmacist intervention resulted in a statistically significant decrease in the time to targeted antibiotic therapy.

摘要

快速分子诊断检测(MDT)是一种用于识别几种不同革兰氏阴性菌及其基因耐药标志物的检测方法。然而,快速MDT与药剂师参与相结合时的影响尚未明确。为了确定在使用快速MDT时药剂师参与对患者预后的影响。主要结局指标是从革兰氏染色结果到首次给予目标抗生素的时间。这是一项在社区医院对革兰氏阴性菌血症患者进行的单中心、准实验性、一组前后测设计研究。纳入18岁及以上的住院患者,前提是他们有革兰氏阴性血培养结果。如果患者在培养结果出来之前出院或死亡,则将其排除。在自动MDT实施前后对患者的结局进行比较。根据西佛罗里达医疗保健机构的规定并按照机构政策,本研究被确定免于机构审查委员会的监督。使用快速MDT联合药剂师干预导致目标抗生素治疗时间在统计学上显著缩短(干预前组,n = 77,44.8±17.8小时;干预后组,n = 80,4.4±5.8小时;P≤.001)。次要结局指标之间未发现显著差异。局限性包括样本量小以及记录不一致。使用快速MDT联合药剂师干预导致目标抗生素治疗时间在统计学上显著缩短。

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