Kuruma Kenta, Funakoshi Hanako, Shibata Meiwa, Okita Keiko, Suwa Junichi, Tame Tomoyuki, Horikoshi Yuho
Division of Infectious Diseases, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN.
Department of Infectious Diseases and General Pediatrics, Nagano Children's Hospital, Nagano, JPN.
Cureus. 2024 Aug 6;16(8):e66282. doi: 10.7759/cureus.66282. eCollection 2024 Aug.
With the advent of multiplex polymerase chain reaction (PCR) using samples from a positive blood culture, the time required to identify a pathogen has significantly shortened to a few hours. It can help us select appropriate antimicrobial agents more quickly. The present study aimed to assess the impact of using a multiplex PCR blood culture panel on the appropriate administration of antimicrobial agents.
Patients aged <16 years with culture-confirmed bacteremia at Tokyo Metropolitan Children's Medical Center were enrolled. A pre-intervention period (period I: December 2016 to December 2018) and a post-intervention period with multiplex PCR use for the confirmation of positive blood cultures (period II: December 2019 to December 2021) were compared for their effect on the use of antimicrobial agents for gram-positive cocci (GPC) and gram-negative rod (GNR) bacteremia. Data on patient background, blood culture results, and antimicrobial use were retrospectively collected from electronic medical records.
Periods I and II had 174 and 154 patients, respectively. The median age at periods I and II was 14 (IQR 2-82) months and 12 (IQR 1-78) months, respectively. GPC bacteremia during periods I and II occurred in 140 and 115 patients, respectively. GNR during periods I and II occurred in 34 and 39 patients, respectively. Neither the vancomycin-resistance genes A/B nor the carbapenem-resistance gene were detected. The use of antimicrobial agents against anti-methicillin-resistant (MRSA) for GPC bacteremia decreased from 103/140 cases (73%) in period I to 56/115 cases (49%) in period II (p=0.047). The use of carbapenems for GNR bacteremia did not change significantly, at 23/34 (68%) in period I and 34/39 (87%) in period II (p=0.47).
Introducing multiplex PCR for pediatric bacteremia decreased the use of anti-MRSA antimicrobial agents but not of carbapenems.
随着使用阳性血培养样本的多重聚合酶链反应（PCR）的出现，鉴定病原体所需的时间已显著缩短至数小时。它可以帮助我们更快地选择合适的抗菌药物。本研究旨在评估使用多重PCR血培养检测板对抗菌药物合理使用的影响。
纳入东京都儿童医疗中心确诊为菌血症的16岁以下患者。比较干预前期（第一阶段：2016年12月至2018年12月）和使用多重PCR确认血培养阳性的干预后期（第二阶段：2019年12月至2021年12月）对革兰氏阳性球菌（GPC）和革兰氏阴性杆菌（GNR）菌血症抗菌药物使用的影响。从电子病历中回顾性收集患者背景、血培养结果和抗菌药物使用数据。
第一阶段和第二阶段分别有174例和154例患者。第一阶段和第二阶段的中位年龄分别为14（四分位间距2 - 82）个月和12（四分位间距1 - 78）个月。第一阶段和第二阶段的GPC菌血症分别发生在140例和115例患者中。第一阶段和第二阶段的GNR分别发生在34例和39例患者中。未检测到万古霉素耐药基因A/B和碳青霉烯耐药基因。针对GPC菌血症使用抗耐甲氧西林（MRSA）抗菌药物的比例从第一阶段的103/140例（73%）降至第二阶段的56/115例（49%）（p = 0.047）。针对GNR菌血症使用碳青霉烯类药物的比例无显著变化，第一阶段为23/34（68%），第二阶段为34/39（87%）（p = 0.47）。
在儿科菌血症中引入多重PCR可减少抗MRSA抗菌药物的使用，但不能减少碳青霉烯类药物的使用。
