Alviset S, Rodari S, Poupet H, Mizrahi A, Gastli N, Philippart F, Charpentier J, Pilmis B, Kernéis S
Université Paris Cité, Faculté de Médecine, F-75006 Paris, France; Equipe Mobile d'Infectiologie, AP-HP, Hôpital Cochin, F-75014 Paris, France; Médecine Intensive et Réanimation, Hôpital Delafontaine, Saint-Denis, France.
Service de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
Infect Dis Now. 2023 Oct;53(8):104773. doi: 10.1016/j.idnow.2023.104773. Epub 2023 Aug 22.
Timely and appropriate therapy is critical in patients with Gram-negative bloodstream infections (GNBSI). Most bacteriology laboratories process blood specimen in the daytime, during laboratory operating hours, and use conventional culture for antimicrobial susceptibility testing (AST). We simulated the potential impact of real-time processing and rapid AST (7 hours) on early adaptation of the antibiotic regimen in intensive care unit (ICU) patients with GNBSI.
All GNBSI episodes occurring in the ICUs of 2 hospitals in Paris were included. Data were collected. For each episode of bacteremia, we simulated the impact of three strategies: (1) Real-time processing coupled with conventional techniques (Gram stain and standard AST); (2) Standard processing coupled with rapid AST; and (3) Real-time processing coupled with rapid AST.
We included 109 episodes in 98 patients. Forty-two patients (48%) died during ICU stay. AST results led to a change of the antibiotic regimen in 66 (61%) episodes, mainly de-escalation (54/109, 55%). In standard care, median time from sample collection to definitive AST result was 65.9 hours (±26.7). The three strategies would have reduced time-to-result by 9.2 hours (±7.1), 30.8 hours (±19.7) and 40.0 hours (±20.6) respectively. Compared to standard care, strategies 1, 2 and 3 would have avoided 20, 69 and 90 patient-days of broad-spectrum antibiotics respectively.
In addition to real-time processing of blood samples, rapid AST would be the most effective strategy to shorten time-to-result in critical patients with GNBSI.
对于革兰氏阴性菌血流感染（GNBSI）患者，及时且恰当的治疗至关重要。大多数细菌学实验室在白天实验室工作时间处理血标本，并使用传统培养方法进行抗菌药物敏感性试验（AST）。我们模拟了实时处理和快速AST（7小时）对重症监护病房（ICU）中GNBSI患者早期调整抗生素治疗方案的潜在影响。
纳入巴黎两家医院ICU发生的所有GNBSI病例。收集数据。对于每一例菌血症病例，我们模拟了三种策略的影响：（1）实时处理结合传统技术（革兰氏染色和标准AST）；（2）标准处理结合快速AST；（3）实时处理结合快速AST。
我们纳入了98例患者的109例病例。42例患者（48%）在ICU住院期间死亡。AST结果导致66例（61%）病例的抗生素治疗方案发生改变，主要是降阶梯治疗（54/109，55%）。在标准治疗中，从样本采集到最终AST结果的中位时间为65.9小时（±26.7）。这三种策略分别可将报告结果时间缩短9.2小时（±7.1）、30.8小时（±19.7）和40.0小时（±20.6）。与标准治疗相比，策略1、2和3分别可避免20、69和90个患者日的广谱抗生素使用。
除了血标本的实时处理外，快速AST将是缩短GNBSI重症患者报告结果时间的最有效策略。
