Anuradha Sharma, Samaddar Arghadip, Maurya Anand, Hada Vivek, Narula Himanshu, Shrimali Twishi, Gupta Neeraj, Kumar Prawin, Singh Kuldeep, Nag Vijaya Lakshmi
Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Indian J Crit Care Med. 2021 Nov;25(11):1258-1262. doi: 10.5005/jp-journals-10071-23922.
Blood cultures are the most significant samples received in a microbiology laboratory. Good quality control of pre-analytic, analytic, and post-analytic stages can have a significant impact on patient outcomes. Here, we present the improvements brought about by reviewing blood culture data with clinicians at a tertiary care institute in India.
Four-year blood culture data (phase I-February 2014-February 2018) were shared with clinicians in the clinical grand round. Several take-home messages were discussed in a quiz format, and a number of holistic quality control measures were implemented at different levels. Based on observable changes in blood culture reports, another dataset was analyzed and compared in phase II (April 2018-April 2019).
In phase II, the blood culture contamination rate improved from 6 to 2% along with four times reduction in ICU isolates and three times increased isolation of salmonellae and pneumococci. The development of resistance in to carbapenems and piperacillin-tazobactam was reduced. Colistin resistance in ICU isolates hovered around 15%. Vaccine-preventable pneumococcal serotypes were predominant in the under-five age-group. Typhoidal salmonellae were more commonly isolated from adults with 50% showing sensitivity to pefloxacin and 97% to ampicillin, chloramphenicol, and cotrimoxazole. was the leading non- (NAC). Fluconazole resistance was observed in 50% of NAC.
Reviewing blood culture data with clinicians mutually helped us to improve the overall quality of blood culture reports. It had a major impact on epidemiological trends and thus, found to be superior to just sharing an antibiogram with the clinicians.
Sharma A, Samaddar A, Maurya A, Hada V, Narula H, Shrimali T, . Analysis of Blood Culture Data Influences Future Epidemiology of Bloodstream Infections: A 5-year Retrospective Study at a Tertiary Care Hospital in India. Indian J Crit Care Med 2021;25(11):1258-1262.
血培养是微生物实验室接收的最重要样本。对分析前、分析中和分析后阶段进行良好的质量控制会对患者预后产生重大影响。在此,我们介绍了印度一家三级医疗机构通过与临床医生共同审查血培养数据所带来的改进。
在临床大查房时,与临床医生分享了四年的血培养数据(第一阶段——2014年2月至2018年2月)。以问答形式讨论了几条实用信息,并在不同层面实施了多项全面的质量控制措施。根据血培养报告中可观察到的变化,在第二阶段(2018年4月至2019年4月)对另一个数据集进行了分析和比较。
在第二阶段,血培养污染率从6%降至2%,重症监护病房(ICU)分离株减少了四倍,沙门氏菌和肺炎球菌的分离率增加了两倍。对碳青霉烯类和哌拉西林 - 他唑巴坦的耐药性发展有所减少。ICU分离株中的黏菌素耐药率徘徊在15%左右。可通过疫苗预防的肺炎球菌血清型在五岁以下年龄组中占主导地位。伤寒沙门氏菌更常见于成人中,50%对培氟沙星敏感,97%对氨苄西林、氯霉素和复方新诺明敏感。[此处原文缺失部分内容]是主要的非[此处原文缺失部分内容](NAC)。50%的NAC中观察到氟康唑耐药。
与临床医生共同审查血培养数据有助于我们提高血培养报告的整体质量。它对流行病学趋势产生了重大影响,因此,发现它优于仅向临床医生分享抗菌谱。
夏尔马A,萨马德达尔A,莫里亚A,哈达V,纳鲁拉H,什里马利T,[此处原文缺失部分内容]。血培养数据分析对血流感染未来流行病学的影响:印度一家三级护理医院的5年回顾性研究。《印度危重症医学杂志》2021年;25(11):1258 - 1262。