Weng Tzu-Ping, Lo Ching-Lung, Lin Wen-Liang, Lee Jen-Chieh, Li Ming-Chi, Ko Wen-Chien, Lee Nan-Yao
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
J Microbiol Immunol Infect. 2023 Feb;56(1):57-63. doi: 10.1016/j.jmii.2022.07.002. Epub 2022 Jul 19.
Integration of antimicrobial stewardship intervention (ASI) with rapid organism identification has the potential for early customization of antimicrobial therapy and improved clinical outcomes. We aimed to evaluate the impact of this combined approach on antimicrobial therapy-related outcomes in patients with bloodstream infections (BSIs).
A pre-post quasi-experimental study was conducted to analyze the impact of ASI with organism identification via matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) among patients with BSIs. Outcomes were compared to a historic pre-intervention group. The 30-day mortality was the primary endpoint. Secondary outcomes included time to first antibiotic modification, length of hospital stay.
A total of 1004 adult patients with BSIs were included in the final analysis, 519 patients classified into the intervention group and 485 patients in the preintervention group. The patients in the intervention group were younger (66 vs. 70 years, P = 0.02). The 30-day crude mortality (14.6% vs. 29.9%, P < 0.001) was lower, the time to organism identification (72.25 vs. 83.6 h, P < 0.001) and length of hospital stay (12 days vs. 14 days, P < 0.001) were shorter in the intervention group. Acceptance of an ASI was associated with a trend toward a reduced 30-day mortality on multivariable analysis (odds ratio 0.33; 95% CI: 0.24-0.47; P < 0.001).
The ASI combined with MALDI-TOF-MS approach decreased time to organism identification and time to appropriate antimicrobial therapy would achieve a better clinical outcome in the patients with BSIs.
抗菌药物管理干预（ASI）与快速病原体鉴定相结合，有可能实现抗菌治疗的早期定制并改善临床结局。我们旨在评估这种联合方法对血流感染（BSI）患者抗菌治疗相关结局的影响。
进行了一项前后对照的准实验研究，以分析通过基质辅助激光解吸/电离飞行时间质谱（MALDI-TOF-MS）进行病原体鉴定的ASI对BSI患者的影响。将结局与历史干预前组进行比较。30天死亡率是主要终点。次要结局包括首次抗生素调整时间、住院时间。
最终分析共纳入1004例成年BSI患者，519例患者分为干预组，485例患者为干预前组。干预组患者更年轻（66岁对70岁，P = 0.02）。干预组的30天粗死亡率较低（14.6%对29.9%，P < 0.001），病原体鉴定时间较短（72.25小时对83.6小时，P < 0.001），住院时间也较短（12天对14天，P < 0.001）。在多变量分析中，接受ASI与30天死亡率降低的趋势相关（优势比0.33；95% CI：0.24 - 0.47；P < 0.001）。
ASI联合MALDI-TOF-MS方法缩短了病原体鉴定时间和获得适当抗菌治疗的时间，在BSI患者中可取得更好的临床结局。
