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一种用于区分细菌和病毒感染的新型宿主反应检测对患者管理的影响:来自紧急护理环境的真实世界证据

Impact on Patient Management of a Novel Host Response Test for Distinguishing Bacterial and Viral Infections: Real World Evidence from the Urgent Care Setting.

作者信息

Kalmovich Boaz, Rahamim-Cohen Daniella, Shapiro Ben David Shirley

机构信息

Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel.

Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.

出版信息

Biomedicines. 2023 May 22;11(5):1498. doi: 10.3390/biomedicines11051498.

Abstract

Antibiotic overuse and underuse are prevalent in urgent care settings, driven in part by diagnostic uncertainty. A host-based test for distinguishing bacterial and viral infections (MeMed BV) has been clinically validated previously. Here we examined how BV impacts antibiotic prescription in a real-world setting. The intention to treat with antibiotics before the receipt of a BV result was compared with practice after the receipt of a BV result at three urgent care centers. The analysis included 152 patients, 57.9% children and 50.7% female. In total, 131 (86.2%) had a bacterial or viral BV result. Physicians were uncertain about prescription for 38 (29.0%) patients and for 30 (78.9%) of these cases, subsequently acted in accordance with the BV result. Physicians intended to prescribe antibiotics to 39 (29.8%) patients, of whom 17 (43.6%) had bacterial BV results. Among the remaining 22 patients with viral BV results, antibiotic prescriptions were reduced by 40.9%. Overall, the physician prescribed in accordance with BV results in 81.7% of all cases ( < 0.05). In total, the physicians reported that BV supported or altered their decision making in 87.0% of cases ( < 0.05). BV impacts patient management in real-world settings, supporting appropriate antibiotic use.

摘要

抗生素的过度使用和使用不足在紧急护理环境中很普遍,部分原因是诊断存在不确定性。一种用于区分细菌和病毒感染的基于宿主的检测方法(MeMed BV)此前已通过临床验证。在此,我们研究了MeMed BV在实际环境中如何影响抗生素处方。比较了在三个紧急护理中心在收到MeMed BV检测结果之前使用抗生素治疗的意向与收到检测结果后的实际做法。分析纳入了152例患者,其中57.9%为儿童,50.7%为女性。总共有131例(86.2%)患者获得了细菌或病毒的MeMed BV检测结果。医生对38例(29.0%)患者的处方存在不确定性,在这些病例中有30例(78.9%)随后根据MeMed BV检测结果采取了相应行动。医生打算给39例(29.8%)患者开抗生素,其中17例(43.6%)患者的MeMed BV检测结果为细菌感染。在其余22例MeMed BV检测结果为病毒感染的患者中,抗生素处方减少了40.9%。总体而言,在所有病例中,81.7%的医生根据MeMed BV检测结果开了药(P<0.05)。总的来说,医生报告称,在87.0%的病例中,MeMed BV检测结果支持或改变了他们的决策(P<0.05)。MeMed BV在实际环境中影响患者管理,有助于合理使用抗生素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ea3/10216409/c36272a2062b/biomedicines-11-01498-g001.jpg

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