Medical Sciences Postgraduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Infection Control Service, Hospital São Lucas da PUCRS, Porto Alegre, RS, Brazil.
Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) Medical School, Porto Alegre, RS, Brazil.
J Glob Antimicrob Resist. 2022 Mar;28:130-135. doi: 10.1016/j.jgar.2021.12.011. Epub 2021 Dec 18.
This study analysed the impact of antimicrobial stewardship team (AST) evaluation on time to susceptible in vitro therapy and mortality of patients with carbapenem-resistant Enterobacterales (CRE) bacteraemia.
We performed a retrospective cohort study (February 2018 to July 2020) to evaluate the impact of AST evaluation, along with other clinical and microbiological variables, on time to appropriate antibiotics, 14-day mortality and in-hospital mortality in patients aged >18 years with CRE bacteraemia. A Cox regression model was used for multivariate analysis.
A total of 142 patients were included. The proportion of patients who received appropriate antibiotics in the first 5 days after bacteraemia was 82/92 (89.1%) versus 29/50 (58.0%) evaluated and not evaluated by the AST, respectively (P < 0.01). AST evaluation reduced the median time to appropriate therapy (49.8 h vs. 71.1 h; P = 0.01). AST intervention was independently associated with earlier prescription of appropriate therapy (P = 0.02) when controlled for septic shock (P < 0.01) and CRE isolation in the previous 90 days (P = 0.04). Regarding mortality, 51 patients (35.9%) died within 14 days (25.8% vs. 44.7% with and without AST intervention, respectively; P = 0.02) and 82 patients (57.7%) in hospital (52.2% vs. 68.0% evaluated and not evaluated by the AST, respectively; P = 0.08). AST intervention was independently protective for 14-day mortality (P = 0.03) when controlled for septic shock status (P < 0.01).
AST guidance improves the quality of antibiotic prescriptions and clinical outcomes in patients with CRE bacteraemia.
本研究分析了抗菌药物管理团队（AST）评估对碳青霉烯类耐药肠杆菌科（CRE）血流感染患者的体外药敏治疗时间和死亡率的影响。
我们进行了一项回顾性队列研究（2018 年 2 月至 2020 年 7 月），以评估 AST 评估以及其他临床和微生物学变量对 18 岁以上 CRE 血流感染患者的适当抗生素使用时间、14 天死亡率和院内死亡率的影响。使用 Cox 回归模型进行多变量分析。
共纳入 142 例患者。AST 评估组（92 例）和未评估组（50 例）在血流感染后第 5 天内接受适当抗生素治疗的患者比例分别为 82/92（89.1%）和 29/50（58.0%）（P<0.01）。AST 评估降低了中位适当治疗时间（49.8 h 比 71.1 h；P=0.01）。在控制脓毒性休克（P<0.01）和 90 天内 CRE 分离（P=0.04）的情况下，AST 干预与更早地开具适当治疗方案独立相关（P=0.02）。在 14 天内死亡方面，51 例患者（35.9%）死亡（AST 干预组和未干预组分别为 25.8%和 44.7%；P=0.02），82 例患者（57.7%）住院（AST 干预组和未干预组分别为 52.2%和 68.0%；P=0.08）。在控制脓毒性休克状态（P<0.01）的情况下，AST 干预对 14 天死亡率具有独立保护作用（P=0.03）。
AST 指导可改善 CRE 血流感染患者的抗生素处方质量和临床结局。
