Messiaen Anne-Sophie, Vandendriessche Stien, De Muynck Emilie, Strubbe Gregory, De Bus Liesbet, Schelstraete Petra, Decommer Kristen, De Smet Sanne, Soetens Alexander, Naesens Leslie, Timmermans Katrien, De Waele Jan J, Veld Diana Huis In 't, Boelens Jerina
Laboratory of Medical Microbiology, Ghent University Hospital, Ghent, Belgium.
Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
Eur J Clin Microbiol Infect Dis. 2025 Apr;44(4):847-853. doi: 10.1007/s10096-025-05046-3. Epub 2025 Jan 25.
Mortality and morbidity of patients with bloodstream infection (BSI) remain high despite advances in diagnostic methods and efforts to speed up reporting. This study investigated the impact of reporting rapid Minimum Inhibitory Concentration (MIC)-results in Gram negative BSIs with the ASTar system (Q-linea, Uppsala, Sweden) on the adaptation of empirically started antimicrobial therapy. We performed a real-world study during which antimicrobial susceptibility testing (AST) results were instantly reported to the treating physician in an established multidisciplinary antimicrobial stewardship setting.
Consecutive patients with Gram negative bacteremia were included in the study (monomicrobial Gram stain, life expectancy of at least 48 h and flagging positive before 2 PM). Rapid AST (RAST) reporting with ASTar was added on top of the standard workflow. Technical performance of the system was evaluated as well as the impact on antimicrobial treatment and timelines of achieving effective and optimal antimicrobial therapy.
A total of 79 analyses were performed in 77 patients, of which 68 episodes were eligible for analysis. A categorical agreement was observed in 97,5% of 1160 MIC results without false susceptible results. All patients on ineffective empirical therapy (12/68) were switched after a median time of approximately one hour (5 min - 15 h) after communication of the result. Furthermore, 20/55 non-optimal therapies were adapted within a median period of 3 h after communication.
The implementation of rapid MICs, measured by the ASTar system, in our low antimicrobial resistance setting with elaborate antimicrobial guidelines, was easy and led to early adaptation of empirical treatment in 32/55 instances (12 ineffective and 20 non-optimal therapy).
NCT06218277 (date of registration: 18-12-2023).
尽管诊断方法有所进步且加快报告的努力不断，但血流感染（BSI）患者的死亡率和发病率仍然很高。本研究调查了使用ASTar系统（瑞典乌普萨拉的Q-linea公司）报告革兰氏阴性菌血流感染的快速最低抑菌浓度（MIC）结果对经验性起始抗菌治疗调整的影响。我们进行了一项真实世界研究，在此期间，在既定的多学科抗菌药物管理环境中，抗菌药物敏感性试验（AST）结果会立即报告给治疗医生。
连续纳入革兰氏阴性菌血症患者（单微生物革兰氏染色、预期寿命至少48小时且下午2点前标记为阳性）。在标准工作流程之上增加使用ASTar进行快速AST（RAST）报告。评估了该系统的技术性能以及对抗菌治疗的影响和实现有效且最佳抗菌治疗的时间线。
共对77例患者进行了79次分析，其中68例符合分析条件。在1160个MIC结果中，97.5%观察到分类一致性，无假敏感结果。所有接受无效经验性治疗的患者（12/68）在结果传达后中位时间约1小时（5分钟 - 15小时）后更换了治疗方案。此外，20/55例非最佳治疗在结果传达后中位3小时内进行了调整。
在我们具有详细抗菌指南的低抗菌药物耐药环境中，采用ASTar系统测量快速MIC很容易，并且在32/55例（12例无效治疗和20例非最佳治疗）中导致了经验性治疗的早期调整。
NCT06218277（注册日期：2023年12月18日）。
