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Abstract：
BACKGROUND: Data on the benefits of rapid microbiological testing on antimicrobial consumption (AC) and antimicrobial resistance patterns (ARPs) are scarce. We evaluated the impact of a protocol based on rapid techniques on AC and ARP in intensive care (ICU) patients.
METHODS: A retrospective pre- (2018) and post-intervention (2019-2021) study was conducted in ICU patients. A rapid diagnostic algorithm was applied starting in 2019 in patients with a lower respiratory tract infection. The incidence of nosocomial infections, ARPs, and AC as DDDs (defined daily doses) were monitored.
RESULTS: A total of 3635 patients were included: 987 in the pre-intervention group and 2648 in the post-intervention group. The median age was 60 years, the sample was 64% male, and the average APACHE II and SOFA scores were 19 points and 3 points. The overall ICU mortality was 17.2% without any differences between the groups. An increase in the number of infections was observed in the post-intervention group (44.5% vs. 17.9%, p < 0.01), especially due to an increase in the incidence of ventilator-associated pneumonia (44.6% vs. 25%, p < 0.001). AC decreased from 128.7 DDD in 2018 to 66.0 DDD in 2021 (rate ratio = 0.51). An increase in Pseudomonas aeruginosa susceptibility of 23% for Piperacillin/tazobactam and 31% for Meropenem was observed.
CONCLUSIONS: The implementation of an algorithm based on rapid microbiological diagnostic techniques allowed for a significant reduction in AC and ARPs without affecting the prognosis of critically ill patients.
METHODS: A retrospective pre- (2018) and post-intervention (2019-2021) study was conducted in ICU patients. A rapid diagnostic algorithm was applied starting in 2019 in patients with a lower respiratory tract infection. The incidence of nosocomial infections, ARPs, and AC as DDDs (defined daily doses) were monitored.
RESULTS: A total of 3635 patients were included: 987 in the pre-intervention group and 2648 in the post-intervention group. The median age was 60 years, the sample was 64% male, and the average APACHE II and SOFA scores were 19 points and 3 points. The overall ICU mortality was 17.2% without any differences between the groups. An increase in the number of infections was observed in the post-intervention group (44.5% vs. 17.9%, p < 0.01), especially due to an increase in the incidence of ventilator-associated pneumonia (44.6% vs. 25%, p < 0.001). AC decreased from 128.7 DDD in 2018 to 66.0 DDD in 2021 (rate ratio = 0.51). An increase in Pseudomonas aeruginosa susceptibility of 23% for Piperacillin/tazobactam and 31% for Meropenem was observed.
CONCLUSIONS: The implementation of an algorithm based on rapid microbiological diagnostic techniques allowed for a significant reduction in AC and ARPs without affecting the prognosis of critically ill patients.
摘要：
背景：关于快速微生物测试对抗菌素消耗（AC）和抗菌素耐药模式（ARPs）的益处的数据很少。我们评估了基于快速技术的协议对重症监护（ICU）患者的AC和ARP的影响。
方法：在ICU患者中进行了一项回顾性的干预前（2018年）和干预后（2019-2021年）研究。从2019年开始，一种快速诊断算法应用于下呼吸道感染患者。医院感染的发生率，ARPS,和AC作为DDDs（定义的每日剂量）进行监测。
结果：共纳入3635例患者：干预前987例，干预后2648例。中位年龄为60岁,样本是64%的男性，APACHEⅡ和SOFA平均得分为19分和3分。ICU总死亡率为17.2%，组间无差异。在干预后观察到感染数量增加（44.5%vs.17.9%,p<0.01),特别是由于呼吸机相关性肺炎的发病率增加(44.6%vs.25%,p<0.001)。AC从2018年的128.7DDD下降到2021年的66.0DDD（比率=0.51）。观察到铜绿假单胞菌对哌拉西林/他唑巴坦的敏感性增加了23％，对美罗培南的敏感性增加了31％。
结论：基于快速微生物诊断技术的算法的实施可以显着减少AC和ARPs，而不会影响危重患者的预后。
方法：在ICU患者中进行了一项回顾性的干预前（2018年）和干预后（2019-2021年）研究。从2019年开始，一种快速诊断算法应用于下呼吸道感染患者。医院感染的发生率，ARPS,和AC作为DDDs（定义的每日剂量）进行监测。
结果：共纳入3635例患者：干预前987例，干预后2648例。中位年龄为60岁,样本是64%的男性，APACHEⅡ和SOFA平均得分为19分和3分。ICU总死亡率为17.2%，组间无差异。在干预后观察到感染数量增加（44.5%vs.17.9%,p<0.01),特别是由于呼吸机相关性肺炎的发病率增加(44.6%vs.25%,p<0.001)。AC从2018年的128.7DDD下降到2021年的66.0DDD（比率=0.51）。观察到铜绿假单胞菌对哌拉西林/他唑巴坦的敏感性增加了23％，对美罗培南的敏感性增加了31％。
结论：基于快速微生物诊断技术的算法的实施可以显着减少AC和ARPs，而不会影响危重患者的预后。
