PDF(Pubmed)
Abstract：
Rapid microbiological reports to clinicians are related to improved clinical outcomes. We conducted a 3-year quasi-experimental design, specifically a pretest-posttest single group design in a university medical center, to evaluate the clinical impact of rapid microbiological identification information using MALDI-TOF MS on optimizing antibiotic prescription. A total of 363 consecutive hospitalized patients with bacterial infections were evaluated comparing a historical control group (CG) (n = 183), in which the microbiological information (bacterial identification and antibiotic susceptibility) was reported jointly to the clinician between 18:00 h and 22:00 h of the same day and a prospective intervention group (IG) (n = 180); the bacterial identification information was informed to the clinician as soon as it was available between 12:00 h and 14:00 h and the antibiotic susceptibility between 18:00 h and 22:00 h). We observed, in favor of IG, a statistically significant decrease in the information time (11.44 h CG vs. 4.48 h IG (p < 0.01)) from the detection of bacterial growth in the culture medium to the communication of identification. Consequently, the therapeutic optimization was improved by introducing new antibiotics in the 10-24 h time window (p = 0.05) and conversion to oral route (p = 0.01). Additionally, we observed a non-statistically significant decrease in inpatient mortality (global, p = 0.15; infection-related, p = 0.21) without impact on hospital length of stay. In conclusion, the rapid communication of microbiological identification to clinicians reduced reporting time and was associated with early optimization of antibiotic prescribing without worsening clinical outcomes.
摘要：
向临床医生提供快速的微生物报告与改善的临床结果有关。我们进行了为期3年的准实验设计,特别是大学医学中心的前测-后测单组设计，评估使用MALDI-TOFMS快速微生物鉴定信息对优化抗生素处方的临床影响。对363例细菌感染的连续住院患者进行了评估，比较了历史对照组（CG）（n=183），其中微生物学信息（细菌鉴定和抗生素敏感性）在当天的18:00h至22:00h之间联合报告给临床医生和前瞻性干预组（IG）（n=180）；细菌鉴定信息在12:00h至14:00h之间获得，抗生素敏感性在18:00h至22:00h之间立即通知给临床医生）。我们观察到,赞成IG，信息时间的统计显着减少(11.44hCG与4.48hIG（p<0.01））从检测培养基中的细菌生长到通讯鉴定。因此,通过在10-24h时间窗(p=0.05)内引入新的抗生素并转换为口服途径(p=0.01),改善了治疗优化.此外,我们观察到住院患者死亡率的下降无统计学意义(全球，p=0.15；感染相关，p=0.21)对住院时间无影响。总之,与临床医师快速沟通微生物鉴定减少了报告时间,并且与早期优化抗生素处方相关,且不会恶化临床结局.
