Okamoto Mai, Maejima Makoto, Goto Taichiro, Mikawa Takahiro, Hosaka Kazuhiro, Nagakubo Yuki, Hirotsu Yosuke, Amemiya Kenji, Sueki Hitomi, Omata Masao
Department of Internal Medicine, Yamanashi Central Hospital, Kofu 400-8506, Japan.
Clinical Laboratory Center, Yamanashi Central Hospital, Kofu 400-8506, Japan.
Diagnostics (Basel). 2023 Jun 1;13(11):1935. doi: 10.3390/diagnostics13111935.
Bacteremia is a serious disease with a reported mortality of 30%. Appropriate antibiotic use with a prompt blood culture can improve patient survival. However, when bacterial identification tests based on conventional biochemical properties are used, it takes 2 to 3 days from positive blood culture conversion to reporting the results, which makes early intervention difficult. Recently, FilmArray (FA) multiplex PCR panel for blood culture identification was introduced to the clinical setting. In this study, we investigated the clinical impact of the FA system on decision making for treating septic diseases and its association with patients' survival. Our hospital introduced the FA multiplex PCR panel in July 2018. In this study, blood-culture-positive cases submitted between January and October 2018 were unbiasedly included, and clinical outcomes before and after the introduction of FA were compared. The outcomes included (i) the duration of use of broad-spectrum antibiotics, (ii) the time until the start of anti-MRSA therapy to MRSA bacteremia, and (iii) sixty-day overall survival. In addition, multivariate analysis was used to identify prognostic factors. In the FA group, overall, 122 (87.8%) microorganisms were concordantly retrieved with the FA identification panel. The duration of ABPC/SBT use and the start-up time of anti-MRSA therapy to MRSA bacteremia were significantly shorter in the FA group. Sixty-day overall survival was significantly improved by utilizing FA compared with the control group. In addition, multivariate analysis identified Pitt score, Charlson score, and utilization of FA as prognostic factors. In conclusion, FA can lead to the prompt bacterial identification of bacteremia and its effective treatment, thus significantly improving survival in patients with bacteremia.
菌血症是一种严重疾病,据报道死亡率为30%。及时进行血培养并合理使用抗生素可提高患者生存率。然而,使用基于传统生化特性的细菌鉴定试验时,从血培养转为阳性到报告结果需要2至3天,这使得早期干预变得困难。最近,用于血培养鉴定的FilmArray(FA)多重PCR检测板被引入临床。在本研究中,我们调查了FA系统对脓毒症治疗决策的临床影响及其与患者生存率的关联。我院于2018年7月引入了FA多重PCR检测板。在本研究中,无偏倚地纳入了2018年1月至10月期间提交的血培养阳性病例,并比较了引入FA前后的临床结果。结果包括:(i)广谱抗生素的使用持续时间;(ii)耐甲氧西林金黄色葡萄球菌(MRSA)菌血症开始抗MRSA治疗的时间;(iii)60天总生存率。此外,采用多变量分析来确定预后因素。在FA组中,总体而言,122种(87.8%)微生物与FA鉴定检测板的结果一致。FA组中阿莫西林/舒巴坦(ABPC/SBT)的使用持续时间以及MRSA菌血症抗MRSA治疗的启动时间显著缩短。与对照组相比,使用FA可显著提高60天总生存率。此外,多变量分析确定了皮特评分、查尔森评分以及FA的使用为预后因素。总之,FA能够快速鉴定菌血症的病原菌并进行有效治疗,从而显著提高菌血症患者的生存率。