Demir Mervenur, Telli-Dizman Gülçin, Hazırolan Gülşen, Uzun Ömrüm, Metan Gökhan
Department of Medical Microbiology, Hacettepe University School of Medicine, Ankara, Türkiye.
Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Türkiye.
Infect Dis Clin Microbiol. 2024 Jun 28;6(2):123-132. doi: 10.36519/idcm.2024.334. eCollection 2024 Jun.
The rise of antibiotic-resistant organisms necessitates the implementation of rapid identification (ID) and antibiotic susceptibility testing (AST) methods for patient management. We aimed to analyze how rapid ID and AST reporting influenced clinicians' treatment decisions.
Bacteria were identified directly from positive blood cultures (BC) using serum separator tubes and MALDI-TOF MS. EUCAST rapid antibiotic susceptibility testing (RAST) method was performed for AST. The impact of rapid ID and AST reports on clinician treatment decisions was evaluated through clinical documentation. The appropriateness of antimicrobial therapy and interventions was assessed according to institutional antimicrobial prescribing guidelines, AST results, and clinical data.
A total of 128 BC bottles from 86 patients underwent processing. The rapid ID method was successful in 105 (82.1%) bottles obtained from 76 patients. The rapid ID results were reviewed by the Infectious Diseases Team on the same day for 55 (72.4%) of the 76 patients. Following the evaluation, new treatments or interventions were recommended for 28 (36.8%) patients. RAST results were available for 24 patients. The susceptibility profile of seven patients was assessed by the Infectious Diseases Team on the same day. Antimicrobial treatment was escalated in four cases, and de-escalation was made in two based on RAST results. If all rapid results had been assessed, adjustments could have been made for eight (10.5%) and eleven (14.5%) more patients, according to ID and RAST results, respectively.
Implementation of rapid ID and AST may contribute to patient management. Although rapid reporting was made, some results were not evaluated by the clinician on the same day, indicating that communication between the clinician and the laboratory needs to be strengthened.
抗生素耐药菌的增多使得有必要采用快速鉴定（ID）和抗生素敏感性试验（AST）方法来进行患者管理。我们旨在分析快速ID和AST报告如何影响临床医生的治疗决策。
使用血清分离管和基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）直接从阳性血培养（BC）中鉴定细菌。采用欧洲抗菌药物敏感性试验委员会（EUCAST）的快速抗生素敏感性试验（RAST）方法进行AST。通过临床记录评估快速ID和AST报告对临床医生治疗决策的影响。根据机构抗菌药物处方指南、AST结果和临床数据评估抗菌治疗和干预措施的合理性。
对来自86例患者的128瓶血培养瓶进行了处理。从76例患者获得的105瓶（82.1%）中，快速ID方法成功。76例患者中的55例（72.4%）在同一天由感染病团队对快速ID结果进行了审核。评估后，为28例（36.8%）患者推荐了新的治疗或干预措施。24例患者获得了RAST结果。同一天，感染病团队对7例患者的药敏谱进行了评估。根据RAST结果，4例患者的抗菌治疗升级，2例患者的抗菌治疗降级。如果对所有快速结果进行评估，根据ID和RAST结果，分别可能会为多8例（10.5%）和11例（14.5%）患者进行调整。
实施快速ID和AST可能有助于患者管理。尽管进行了快速报告，但一些结果在同一天未被临床医生评估，这表明临床医生与实验室之间的沟通需要加强。
