Keri Vishakh C, Gupta Ankesh, Mohapatra Sarita, Soneja Manish, Kapil Arti, Xess Immaculata, Wig Naveet, Das Bimal Kumar
Department of Medicine and Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Infez Med. 2024 Sep 1;32(3):330-339. doi: 10.53854/liim-3203-7. eCollection 2024.
MALDI-TOF-MS facilitates the identification of microorganisms from positive cultures in a timely and accurate manner. It eliminates the necessity for the application of biochemicals and operates on the principle of proteomics. It decreases the time required to report culture results. Prompt detection and notification of the pathogen, prior to the disclosure of antimicrobial susceptibilities, could potentially shorten the duration until the initial antibiotic adjustment is necessary, thereby influencing patients' clinical prognoses.
Fifty patients in the conventional arm and one hundred patients in the interventional arm were compared in a pre and post quasi-experimental study conducted at a tertiary care centre in North India. Patients with positive cultures from medical wards and intensive care units were included. Comparing the time to first antibiotic modification after culture positivity, MALDI-TOF-MS-based identification, and clinical outcomes in both arms was the primary objective. Antibiotic modifications, escalation, and de-escalation were all recorded.
The intervention arm exhibited a substantially shorter median time to first antibiotic modification (2010 mins vs 2905 mins, p=0.002) than the conventional arm. In the interventional group, a total of 44 out of 100 antibiotic modifications were implemented. Of these, 19 (43.3%) were determined solely by the MALDI report, without the anticipation of susceptibility assessments. De-escalation of antibiotics constituted the pre-dominant form of modification (47.4%). The difference between the 27% and 32% mortality rates in the intervention arm and the conventional arm was not statistically significant (p=0.52).
MALDI-TOF-MS facilitates the modification of antibiotics early on. The primary benefit lies in the reduction of superfluous antibiotic usage. Early organism identification and reporting prior to the availability of susceptibility results did not result in any mortality benefit. This strategy, when combined with a strong antimicrobial stewardship programme, can aid in the reduction of antibiotic use.
基质辅助激光解吸电离飞行时间质谱（MALDI-TOF-MS）有助于及时、准确地从阳性培养物中鉴定微生物。它无需使用生化试剂，基于蛋白质组学原理运行。它减少了报告培养结果所需的时间。在披露抗菌药物敏感性之前，病原体的及时检测和通报可能会缩短首次进行抗生素调整所需的时间，从而影响患者的临床预后。
在印度北部一家三级医疗中心进行的一项前后对照准实验研究中，对传统组的50名患者和干预组的100名患者进行了比较。纳入了来自内科病房和重症监护病房培养结果为阳性的患者。比较两组培养结果呈阳性后首次抗生素调整的时间、基于MALDI-TOF-MS的鉴定结果以及临床结局是主要目的。记录了抗生素的调整、升级和降级情况。
干预组首次抗生素调整的中位时间（2010分钟对2905分钟，p=0.002）明显短于传统组。在干预组中，100次抗生素调整中有44次得以实施。其中，19次（43.3%）仅根据MALDI报告确定，无需等待敏感性评估。抗生素降级是主要的调整形式（47.4%）。干预组和传统组27%和32%的死亡率差异无统计学意义（p=0.52）。
MALDI-TOF-MS有助于早期调整抗生素。主要益处在于减少不必要的抗生素使用。在获得敏感性结果之前进行早期病原体鉴定和报告并未带来任何死亡率方面的益处。该策略与强有力的抗菌药物管理计划相结合，有助于减少抗生素的使用。
