Ilges Dan, Graf Erin H, Grant Leah, Long Ashley, Siebeneck Eric, Seville Maria Teresa, Grys Thomas, Speiser Lisa J
Department of Pharmacy Services, Mayo Clinic Arizona, Phoenix, AZ, USA.
Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, AZ, USA.
Infect Control Hosp Epidemiol. 2024 Nov 26;46(1):1-6. doi: 10.1017/ice.2024.180.
Multiplex polymerase chain reaction (PCR) panels for stool testing may be used to diagnose , which can circumvent more appropriate targeted testing, resulting in treatment of incidentally detected colonization. We sought to reduce diagnosis via a gastrointestinal pathogen panel (GIPP).
Quasi-experimental, pre/post, retrospective cohort study from January 1, 2022, to January 31, 2024.
Mayo Clinic Arizona-a single academic medical center and associated clinics.
Adult patients receiving testing and/or treatment.
Preferred testing consisted of glutamate dehydrogenase and toxin antigen immunoassay, followed by toxin gene testing for discrepant results. The GIPP contained 22 targets during the baseline period with removed during the postintervention period. Surveys were provided to provider and nursing groups, separately, to identify ordering practices and knowledge gaps.
At baseline, from January 1, 2022, to January 31, 2023, 2,772 GIPPs were completed for 2,307 unique patients (∼7 per day), primarily for outpatients (1,805 of 2,772, 65%). The most common positive target was (517 of 1,018, 51%), which resulted in treatment for infection in 94.9% (337 of 355) of cases. Following GIPP target removal, GIPP orders decreased from 3.23 to 2.7 per 1,000 patient visits ( < .001). Prescribing of treatments decreased in the postintervention period in inpatient and outpatient settings. There were no cases of delayed diagnosis during the postintervention period.
Removing from the GIPP resulted in effective diagnostic and antimicrobial stewardship without resulting in delayed diagnoses.
用于粪便检测的多重聚合酶链反应（PCR）检测板可能用于诊断，这可能会规避更合适的靶向检测，从而导致对偶然检测到的定植进行治疗。我们试图通过胃肠道病原体检测板（GIPP）减少诊断。
2022年1月1日至2024年1月31日的准实验性、前后对照、回顾性队列研究。
亚利桑那州梅奥诊所——一个单一的学术医疗中心及相关诊所。
接受检测和/或治疗的成年患者。
首选检测包括谷氨酸脱氢酶和毒素抗原免疫测定，随后对结果不一致的情况进行毒素基因检测。GIPP在基线期包含22个靶点，干预后期移除了其中一个。分别向医疗人员和护理团队进行调查，以确定检测的订购情况和知识差距。
在基线期，即2022年1月1日至2023年1月31日，为2307名不同患者完成了2772次GIPP检测（每天约7次），主要针对门诊患者（2772例中的1805例，占65%）。最常见的阳性靶点是艰难梭菌（1018例中的517例，占51%），这导致94.9%（355例中的337例）的病例因艰难梭菌感染而接受治疗。在移除GIPP的一个靶点后，GIPP检测订单从每1000次患者就诊3.23次降至2.7次（P<.001）。在干预后期，住院和门诊环境中艰难梭菌治疗的处方量减少。干预后期没有出现艰难梭菌诊断延迟的情况。
从GIPP中移除艰难梭菌检测导致了有效的诊断和抗菌药物管理，且未导致诊断延迟。
