Curtoni Antonio, Ghibaudo Davide, Veglio Caterina, Imperatore Luigi, Bianco Gabriele, Castiglione Anna, Ciccone Giovannino, Scaglione Luca, Scabini Silvia, Corcione Silvia, De Rosa Francesco Giuseppe, Costa Cristina, Cavallo Rossana
Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.
Department of Public Health and Paediatrics, University of Turin, Turin, Italy.
J Med Microbiol. 2023 Jan;72(1). doi: 10.1099/jmm.0.001638.
. Rapid identification (ID) and antimicrobial susceptibility testing (AST) of bloodstream infections (BSI) pathogens are fundamental to switch from empirical to targeted antibiotic therapy improving patients outcome and reducing antimicrobial resistance spreading.. The adoption of a rapid microbiological protocol (RP) based on Matrix-Assisted Laser Desorption Ionization-Time Of Flight Mass Spectrometry (MALDI-TOF MS) and Light Scattering Technology (LST) for rapid diagnosis of BSI could positively impact on patients' antimicrobial management.. The study aim was to evaluate a RP for BSI microbiological diagnosis in terms of accuracy, turnaround time (TAT) and potential therapeutic impact.. A prospective observational study was conducted: monomicrobial bacterial blood cultures of septic patients were analysed in parallel by RP and standard protocol (SP). In RP the combination of MALDI-TOF MS and LST was used for rapid ID and AST assessments, respectively. To determine the potential impact of RP on antimicrobial therapy management, clinicians were interviewed on therapeutic decisions based on RP and SP results. RP accuracy, TAT and impact were evaluated in comparison to SP results.. A total of 97 patients were enrolled. ID and AST concordance between RP and SP were 96.9 and 94.7 %, respectively. RP technical and real-life TAT were lower than SP (6.4 h vs. 18.4 h; 9.5 vs. 27.1 h). The agreement between RP- and SP-based therapeutic decisions was 90.7 (90 % CI 84.4-95.1). RP results could produce 24/97 correct antibiotic changes with 18/97 possible de-escalations and 25/97 prompt applications of infection control precautions.. With the application of RP in BSI management, about one-fourth of patients may safely benefit from early targeted antibiotic therapy and infection control policies with one working day in advance in comparison to conventional methods. This protocol is feasible for clinical use in microbiology laboratories and potentially helpful for Antimicrobial Stewardship.
血流感染（BSI）病原体的快速鉴定（ID）和抗菌药物敏感性测试（AST）是从经验性抗生素治疗转向靶向抗生素治疗的基础，可改善患者预后并减少抗菌药物耐药性的传播。采用基于基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）和光散射技术（LST）的快速微生物学方案（RP）对BSI进行快速诊断，可能会对患者的抗菌药物管理产生积极影响。本研究的目的是从准确性、周转时间（TAT）和潜在治疗影响方面评估用于BSI微生物学诊断的RP。进行了一项前瞻性观察研究：对脓毒症患者的单微生物血培养物分别采用RP和标准方案（SP）进行平行分析。在RP中，MALDI-TOF MS和LST的组合分别用于快速ID和AST评估。为了确定RP对抗菌药物治疗管理的潜在影响，就基于RP和SP结果的治疗决策对临床医生进行了访谈。与SP结果相比，评估了RP的准确性、TAT和影响。共纳入97例患者。RP与SP之间的ID和AST一致性分别为96.9%和94.7%。RP的技术TAT和实际TAT均低于SP（6.4小时对18.4小时；9.5小时对27.1小时）。基于RP和SP的治疗决策之间的一致性为90.7（90%CI 84.4-95.1）。RP结果可导致97例患者中有24例正确更换抗生素，其中18例可能实现降阶梯治疗，25例及时采取感染控制预防措施。在BSI管理中应用RP，与传统方法相比，约四分之一的患者可能提前一个工作日安全地从早期靶向抗生素治疗和感染控制策略中获益。该方案在微生物实验室临床应用中可行，对抗菌药物管理可能有帮助。
