Ito Hiroshi, Tomura Yuna, Oshida Jura, Fukui Sayato, Kodama Taisuke, Kobayashi Daiki
Division of General Internal Medicine, Department of Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki, Japan.
Tokyo Medical University Library, Shinjuku, Tokyo, Japan.
Infect Dis Now. 2023 Sep;53(6):104764. doi: 10.1016/j.idnow.2023.104764. Epub 2023 Jul 22.
The number of studies that verify whether Gram stain can help to reduce the use of broad-spectrum antibiotics is relatively limited compared to those evaluating its concordance with culture test results. Thereby, we aimed to evaluate the effectiveness of Gram staining in the reduction of broad-spectrum antibiotics and its impact on clinical outcomes. We systematically reviewed studies having used Gram stain to guide antibiotic selection and evaluated performance measures between 1996 and 2022. We extracted available data on broad-spectrum antibiotic use as a primary outcome of the studies in view of an exploratory meta-analysis designed to estimate the clinical effect of Gram stain. We also evaluated the clinical response and coverage rates of the initial antibiotic therapy. One randomized study and four non-randomized studies were eligible, all of which were conducted in tertiary care hospitals in Japan. Gram stain was associated with reduced broad-spectrum antibiotic use, including antipseudomonal antibiotics (odds ratio [OR], 0.05; 95% confidence interval [CI], 0.01-0.34), anti-methicillin-resistant Staphylococcus aureus antibiotics (OR, 0.21; 95% CI, 0.07-0.63), and carbapenems (OR, 0.07; 95% CI, 0.02-0.19), without impairing clinical outcomes, including clinical response rate (OR, 1.48; 95% CI, 0.95-2.31) and coverage rate of initial antibiotic therapy (OR, 0.70; 95% CI, 0.40-1.22) using random-effects models in our meta-analysis. In conclusion, Gram stain may be useful in guiding initial antibiotic selection without apparent adverse clinical outcomes. However, currently available studies evaluating the clinical usefulness of Gram stain are limited to specific clinical settings.
与评估革兰氏染色与培养测试结果一致性的研究相比，验证革兰氏染色是否有助于减少广谱抗生素使用的研究数量相对有限。因此，我们旨在评估革兰氏染色在减少广谱抗生素使用方面的有效性及其对临床结果的影响。我们系统回顾了1996年至2022年间使用革兰氏染色指导抗生素选择的研究，并评估了相关性能指标。鉴于一项旨在估计革兰氏染色临床效果的探索性荟萃分析，我们提取了有关广谱抗生素使用的可用数据作为研究的主要结果。我们还评估了初始抗生素治疗的临床反应和覆盖率。一项随机研究和四项非随机研究符合条件，所有这些研究均在日本的三级护理医院进行。在我们的荟萃分析中，使用随机效应模型，革兰氏染色与减少广谱抗生素使用相关，包括抗假单胞菌抗生素（优势比[OR]，0.05；95%置信区间[CI]，0.01 - 0.34）、抗耐甲氧西林金黄色葡萄球菌抗生素（OR，0.21；95%CI，0.07 - 0.63）和碳青霉烯类抗生素（OR，0.07；95%CI，0.02 - 0.19），且不影响临床结果，包括临床反应率（OR，1.48；95%CI，0.95 - 2.31）和初始抗生素治疗的覆盖率（OR，0.70；95%CI，0.40 - 1.22）。总之，革兰氏染色可能有助于指导初始抗生素选择，且无明显不良临床结果。然而，目前评估革兰氏染色临床实用性的研究仅限于特定临床环境。
