Khasawneh Rawand A, Almomani Basima A, Al-Shatnawi Samah F, Al-Natour Lara
Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
New Microbes New Infect. 2023 Sep 21;55:101182. doi: 10.1016/j.nmni.2023.101182. eCollection 2023 Oct.
Despite reduced infectious disease mortality and improved survival, infectious diseases continue to pose health threats due to their contagiousness, societal harm, and morbidity. Empiric antibiotic therapy, often prescribed without knowledge of the causative pathogen, faces challenges from rising antibiotic resistance. This study explores the potential of prior positive culture results to guide empiric antibiotic therapy.
Data from King Abdullah University Hospital (Jan 2014-Dec 2019) included adult patients with recurrent bacterial infections (pneumonia, sepsis, UTIs, wounds). Excluded cases included: mixed infections, transfers, <14 days or >12 months between episodes. The study compared bacterial growth and sensitivity patterns between previous and recent cultures.
The study included 970 episodes from 650 patients, mainly UTIs (60.3%) and gram-negative bacteria (77.9%). The study found that (65.1%) of culture pairs matched. Empirical therapy was accurate in (71.8%) of cases. Further, accuracy of selected empiric antibiotic therapy was significantly predicted (p < 0.001) by: type of infection, type of antibiotics, and concordance with prior microbiologic data. Multivariate logistic analysis showed blood culture as less predictive of pending identity (OR: 0.234, P < 0.001) compared to urine culture; and prior affirmed gram negative bacterial culture was less predictive (OR: 0.606, P = 0.021) compared to gram positive bacterial culture.
This study underscores the potential of prior positive culture results in guiding empiric antibiotic therapy, enhancing accuracy and identity agreement. Future research should explore this approach in different infection contexts and across multiple centers. Reducing the indiscriminate use of broad-spectrum antibiotics is essential to combat antibiotic resistance.
尽管传染病死亡率降低且生存率提高，但由于其传染性、社会危害和发病率，传染病仍然构成健康威胁。经验性抗生素治疗通常在未了解致病病原体的情况下开具，面临着抗生素耐药性上升带来的挑战。本研究探讨既往阳性培养结果指导经验性抗生素治疗的潜力。
来自阿卜杜拉国王大学医院（2014年1月至2019年12月）的数据包括患有复发性细菌感染（肺炎、败血症、尿路感染、伤口感染）的成年患者。排除的病例包括：混合感染、转院患者、发作间隔<14天或>12个月的患者。该研究比较了既往培养和近期培养之间的细菌生长及敏感性模式。
该研究纳入了650例患者的970次发作，主要是尿路感染（60.3%）和革兰氏阴性菌（77.9%）。研究发现（65.1%）的培养配对结果相符。经验性治疗在（71.8%）的病例中是准确的。此外，所选经验性抗生素治疗的准确性可通过以下因素显著预测（p<0.001）：感染类型、抗生素类型以及与既往微生物学数据的一致性。多因素逻辑分析显示，与尿培养相比，血培养对待确定病原体的预测性较低（OR：0.234，P<0.001）；与革兰氏阳性菌培养相比,既往确诊的革兰氏阴性菌培养的预测性较低（OR：0.606，P=0.021）。
本研究强调了既往阳性培养结果在指导经验性抗生素治疗、提高准确性和鉴定一致性方面的潜力。未来的研究应在不同的感染背景下和多个中心探索这种方法。减少广谱抗生素的滥用对于对抗抗生素耐药性至关重要。
