Department of Clinical Microbiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 3, 00290 Helsinki, Finland.
Department of Infectious Diseases, HUS Inflammation Center, University of Helsinki and Helsinki University Hospital, Malmin päivystyssairaala, Talvelantie 6, rakennus 2, 00029 HUS, Helsinki, Finland.
EBioMedicine. 2024 Feb;100:104992. doi: 10.1016/j.ebiom.2024.104992. Epub 2024 Feb 1.
Selective reporting is a promising tool for antimicrobial stewardship, but in wound cultures, its effects on the use of antimicrobials are unknown. Our HUS Diagnostic Center Bacteriology laboratory refined its selective reporting protocol for wound cultures during 2017-2018. In this study we aimed to show our protocol's impact on the frequency of antimicrobial escalation.
We performed a retrospective cohort study of patients in the wound-care ward of a primary-care hospital in Helsinki, Finland, from 2014 to 2016 (pre-intervention) and from 2019 to April 2021 (post-intervention). With the inclusion criterion being wound-culture collection, this provided us with 299 patients, of which 152 were in the pre-intervention group, and 147 were post-intervention. We collected the data from medical records and compared the pre-intervention- with the post-intervention group in terms of patient profiles, microbiology reports, antimicrobial treatment, and treatment outcomes.
In the pre-intervention group 40% of the patients were male and 60% female and in the post-intervention group 49% and 51% respectively. The frequency of AST reported had decreased from 63% in the pre-intervention group to 37% post-intervention (OR 0.35, p < 0.001). The post-intervention group demonstrated lower frequencies of antimicrobial treatment 7 d after wound culture collection, 82% pre-intervention vs 58% post-intervention (OR 0.31, p < 0.001), and antimicrobial escalation, 42% vs 20% (OR 0.35, p < 0.001) respectively. Length of hospital stay, and all-cause mortality were similar between the groups.
Selective reporting of wound cultures appears an effective and safe measure to reduce the use of antimicrobials.
HUS Diagnostic Center.
选择性报告是抗菌药物管理的一种有前途的工具，但在伤口培养物中，其对抗菌药物使用的影响尚不清楚。我们的 HUS 诊断中心细菌学实验室在 2017-2018 年期间对伤口培养物的选择性报告方案进行了改进。在这项研究中，我们旨在展示我们方案对抗菌药物升级频率的影响。
我们对芬兰赫尔辛基一家初级保健医院伤口护理病房的患者进行了回顾性队列研究，研究时间为 2014 年至 2016 年（干预前）和 2019 年至 2021 年 4 月（干预后）。纳入标准为采集伤口培养物，共纳入 299 例患者，其中干预前组 152 例，干预后组 147 例。我们从病历中收集数据，并比较了干预前组和干预后组患者的特征、微生物学报告、抗菌治疗和治疗结果。
干预前组患者中，40%为男性，60%为女性，而干预后组中，49%为男性，51%为女性。报告的 AST 频率从干预前组的 63%降至干预后组的 37%（OR 0.35，p<0.001）。干预后组在伤口培养物采集后 7 天，抗菌治疗的频率分别为 7d 82%（干预前）和 58%（干预后）（OR 0.31，p<0.001）和抗菌药物升级，42%（干预前）和 20%（干预后）（OR 0.35，p<0.001），频率均较低。两组患者的住院时间和全因死亡率相似。
选择性报告伤口培养物似乎是一种有效且安全的措施，可以减少抗菌药物的使用。
HUS 诊断中心。
