General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Infect Dis (Lond). 2023 Apr;55(4):255-262. doi: 10.1080/23744235.2023.2169345. Epub 2023 Jan 24.
We investigated the role of infectious disease consultation (IDC) on therapeutic appropriateness in Gram-negative bloodstream infections (GNBSIs) in a setting with a high proportion of antibiotic resistance. Secondary outcomes were in-hospital mortality and the impact of rapid diagnostic tests (RDTs).
Retrospective study on hospitalised patients with GNBSIs. Therapy was deemed appropriate if it had the narrowest spectrum considering infection and patients' characteristics. Interventional-IDC (I-IDC) group included patients with IDC-advised first appropriate or last non-appropriate therapy. Time to first appropriate therapy and survival were evaluated by Kaplan-Meier curves. Factors associated with therapy appropriateness were assessed by multivariate Cox proportional-hazard models.
471 patients were included. High antibiotic resistance rates were detected: quinolones 45.5%, third-generation cephalosporins 37.4%, carbapenems 7.9%. I-IDC was performed in 31.6% of patients (149/471), RDTs in 70.7% (333/471). The 7-day probability of appropriate treatment was 91.9% (95% confidence interval [95%CI]: 86.4-95.8%) vs. 75.8% (95%CI: 70.9-80.4%) with and without I-IDC, respectively (-value = 0.0495); 85.5% (95%CI: 81.3-89.1%) vs. 69.4% (95%CI: 61.3-77.2%) with and without RDTs, respectively (-value = 0.0023). Compared to RDTs alone, the combination with I-IDC was associated with a higher proportion of appropriate therapies at day 7: 81.9% (95%CI: 76.4-86.7%) vs. 92.6% (95%CI: 86.3-96.7%). At multivariate analysis, I-IDC and RDTs were associated with time to first appropriate therapy [adjusted hazard-ratio 1.292 (95%CI: 1.014-1.647) and 1.383 (95%CI: 1.080-1.771), respectively], with no impact on mortality.
In a setting with a high proportion of antibiotic resistance, IDC and RDTs were associated with earlier prescription of appropriate therapy in GNBSIs, without impact on mortality.
我们研究了传染病咨询（IDC）在高抗生素耐药率环境下革兰氏阴性菌血流感染（GNBSI）治疗适宜性中的作用。次要结局为住院死亡率和快速诊断检测（RDT）的影响。
对 GNBSI 住院患者进行回顾性研究。如果治疗方案考虑了感染和患者特征，且具有最窄的抗菌谱，则认为治疗是适宜的。干预性 IDC（I-IDC）组包括接受 IDC 建议的首次适当或末次不适当治疗的患者。通过 Kaplan-Meier 曲线评估首次适当治疗时间和生存情况。采用多变量 Cox 比例风险模型评估与治疗适宜性相关的因素。
共纳入 471 例患者。检测到高抗生素耐药率：喹诺酮类 45.5%，第三代头孢菌素 37.4%，碳青霉烯类 7.9%。31.6%（149/471）的患者进行了 I-IDC，70.7%（333/471）的患者进行了 RDT。有和无 I-IDC 时，第 7 天适当治疗的概率分别为 91.9%（95%置信区间 [95%CI]：86.4-95.8%）和 75.8%（95%CI：70.9-80.4%）（-值=0.0495）；有和无 RDT 时，第 7 天适当治疗的概率分别为 85.5%（95%CI：81.3-89.1%）和 69.4%（95%CI：61.3-77.2%）（-值=0.0023）。与单独使用 RDT 相比，I-IDC 联合使用与第 7 天更高比例的适当治疗相关：81.9%（95%CI：76.4-86.7%）vs. 92.6%（95%CI：86.3-96.7%）。多变量分析显示，I-IDC 和 RDT 与首次适当治疗时间相关[校正后的危险比 1.292（95%CI：1.014-1.647）和 1.383（95%CI：1.080-1.771）]，但与死亡率无关。
在高抗生素耐药率环境中，IDC 和 RDT 与 GNBSI 中更早地开具适当治疗方案相关，与死亡率无关。
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