快速药敏检测对革兰氏阴性菌血流感染抗菌治疗和临床结局的影响。
Impact of rapid susceptibility testing on antimicrobial therapy and clinical outcomes in Gram-negative bloodstream infections.
机构信息
Institute of Infection and Immunity, St George's University of London, London, UK.
Department of Medical Microbiology, Southwest London Pathology, St George's Hospital, London, UK.
出版信息
J Antimicrob Chemother. 2022 Feb 23;77(3):771-781. doi: 10.1093/jac/dkab449.
BACKGROUND
Rapid antimicrobial susceptibility testing (rAST) has the potential to improve care of bloodstream infections.
OBJECTIVES
The aim of this service evaluation was to assess the impact of rAST on antimicrobial therapy and clinical outcomes in patients with Gram-negative bloodstream infection.
METHODS
A prospective service evaluation was conducted from March 2018 to December 2018. A rAST system (Alfred 60AST) was run Monday-Friday before midday and results were communicated to clinicians on the same day as positive blood culture, with subsequent conventional AST performed. Times to antibiotic therapy and clinical outcomes were compared between rAST and conventional AST.
RESULTS
One hundred and ninety-one patients with Gram-negative bacteraemia were included (93 in the rapid group and 98 in the conventional group). Aminoglycoside combination therapy was stopped earlier in the rapid group [32 h (0-795) versus 54 h (4-216), P = 0.002]. The median time to optimal antibiotic based on AST results was significantly shorter than that in the conventional group [50 h (10-339) versus 69.5 h (20-872), P = 0.034]. In the subgroup of patients on ineffective empirical antibiotic, time to effective antibiotic was shorter in the rapid group [39.5 h (32-97) versus 57 h (49-83), P = 0.036]. No differences were found in 28 day mortality or length of stay.
CONCLUSIONS
Rapid susceptibility testing resulted in faster discontinuation of aminoglycosides and a shorter time to starting effective and optimal antibiotic when compared with conventional AST results. rAST has potential clinical benefits and points to the need for larger future studies in areas of high antibiotic resistance.
背景
快速抗菌药敏检测（rAST）有可能改善血流感染的治疗效果。
目的
本服务评估旨在评估 rAST 对革兰氏阴性菌血流感染患者的抗菌治疗和临床结局的影响。
方法
前瞻性服务评估于 2018 年 3 月至 2018 年 12 月进行。周一至周五中午前运行 rAST 系统（Alfred 60AST），当天阳性血培养结果出来时将结果传达给临床医生，随后进行常规 AST。比较 rAST 和常规 AST 的抗生素治疗时间和临床结局。
结果
共纳入 191 例革兰氏阴性菌菌血症患者（快速组 93 例，常规组 98 例）。快速组氨基糖苷类联合治疗停药时间更早[32 h（0-795）与 54 h（4-216），P = 0.002]。根据 AST 结果选择最佳抗生素的中位时间明显短于常规组[50 h（10-339）与 69.5 h（20-872），P = 0.034]。在经验性无效抗生素治疗的患者亚组中，快速组有效抗生素的时间更短[39.5 h（32-97）与 57 h（49-83），P = 0.036]。28 天死亡率或住院时间无差异。
结论
与常规 AST 结果相比，快速药敏检测可更快停止氨基糖苷类药物的使用，并缩短开始使用有效和最佳抗生素的时间。rAST 具有潜在的临床益处，表明在高抗生素耐药性领域需要进行更大规模的未来研究。
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