Abstract：
BACKGROUND: Pretransplant infection screening (IS) of potential organ recipients is essential to optimal outcome of solid organ transplantation (SOT).
METHODS: A pre-post study was performed during 2020-2023 to investigate the impact of the STREAM (Solid organ TRansplant stEwArdship and Multidisciplinary approach) intervention to improve IS in SOT. The intervention, performed in 2022, included the implementation of IS through educational meetings, local guidelines, and the availability of a digital screening tool. The objective of the study was the assessment of IS completion, including a list of 17 laboratory tests and the investigation of vaccination status. The reduction of unnecessary tests was also analyzed. The test of proportions and a multilevel multivariate Poisson regression model were used to compare IS completion before and after STREAM. infectious diseases (ID) consultation and urgent evaluation were investigated as predictors of IS completion.
RESULTS: A total of 171 patients were enrolled, including liver (44%), heart (32%), and kidney (24%) transplant candidates. Mean age was 56 ± 11 years, and most patients (77%) were males. Ninety-five (56%) patients were included before the intervention and 76 (44%) after STREAM. IS completion increased after STREAM (IRR 1.41, p < 0.001) with significant improvement recorded for seven (39%) IS items. Unnecessary tests decreased by 43% after the intervention. ID consultation (IRR 1.13, p = 0.02) and urgent evaluation (p = 0.68, p < 0.001) were predictors of IS improvement.
CONCLUSIONS: STREAM was successful in improving IS completion. Further research is needed to investigate the impact of this intervention on posttransplant infections.
METHODS: A pre-post study was performed during 2020-2023 to investigate the impact of the STREAM (Solid organ TRansplant stEwArdship and Multidisciplinary approach) intervention to improve IS in SOT. The intervention, performed in 2022, included the implementation of IS through educational meetings, local guidelines, and the availability of a digital screening tool. The objective of the study was the assessment of IS completion, including a list of 17 laboratory tests and the investigation of vaccination status. The reduction of unnecessary tests was also analyzed. The test of proportions and a multilevel multivariate Poisson regression model were used to compare IS completion before and after STREAM. infectious diseases (ID) consultation and urgent evaluation were investigated as predictors of IS completion.
RESULTS: A total of 171 patients were enrolled, including liver (44%), heart (32%), and kidney (24%) transplant candidates. Mean age was 56 ± 11 years, and most patients (77%) were males. Ninety-five (56%) patients were included before the intervention and 76 (44%) after STREAM. IS completion increased after STREAM (IRR 1.41, p < 0.001) with significant improvement recorded for seven (39%) IS items. Unnecessary tests decreased by 43% after the intervention. ID consultation (IRR 1.13, p = 0.02) and urgent evaluation (p = 0.68, p < 0.001) were predictors of IS improvement.
CONCLUSIONS: STREAM was successful in improving IS completion. Further research is needed to investigate the impact of this intervention on posttransplant infections.
摘要：
背景：潜在器官受者的移植前感染筛查（IS）对于实体器官移植（SOT）的最佳结果至关重要。
方法：在2020-2023年期间进行了一项事后研究，以调查STREAM（实体器官transplantstEwArdship和多学科方法）干预对改善SOT中IS的影响。干预,在2022年进行，包括通过教育会议实施IS，当地准则,以及数字筛选工具的可用性。这项研究的目的是评估IS的完成情况，包括17项实验室测试清单和疫苗接种状况调查。还分析了不必要测试的减少。比例检验和多水平多变量泊松回归模型用于比较STREAM前后的IS完成情况。研究了传染病(ID)咨询和紧急评估作为IS完成的预测因子.
结果：共纳入171例患者，包括肝脏（44%），心脏（32%），和肾脏（24％）移植候选人。平均年龄56±11岁,大多数患者（77%）是男性。在干预前纳入了95例(56%)患者，在STREAM后纳入了76例(44%)患者。STREAM后IS完成度增加（IRR1.41，p<0.001），其中七个（39％）IS项目有显着改善。干预后，不必要的测试减少了43％。ID咨询（IRR1.13，p=0.02）和紧急评估（p=0.68，p<0.001）是IS改善的预测因素。
结论：STREAM在改善IS完成方面是成功的。需要进一步的研究来调查这种干预措施对移植后感染的影响。
方法：在2020-2023年期间进行了一项事后研究，以调查STREAM（实体器官transplantstEwArdship和多学科方法）干预对改善SOT中IS的影响。干预,在2022年进行，包括通过教育会议实施IS，当地准则,以及数字筛选工具的可用性。这项研究的目的是评估IS的完成情况，包括17项实验室测试清单和疫苗接种状况调查。还分析了不必要测试的减少。比例检验和多水平多变量泊松回归模型用于比较STREAM前后的IS完成情况。研究了传染病(ID)咨询和紧急评估作为IS完成的预测因子.
结果：共纳入171例患者，包括肝脏（44%），心脏（32%），和肾脏（24％）移植候选人。平均年龄56±11岁,大多数患者（77%）是男性。在干预前纳入了95例(56%)患者，在STREAM后纳入了76例(44%)患者。STREAM后IS完成度增加（IRR1.41，p<0.001），其中七个（39％）IS项目有显着改善。干预后，不必要的测试减少了43％。ID咨询（IRR1.13，p=0.02）和紧急评估（p=0.68，p<0.001）是IS改善的预测因素。
结论：STREAM在改善IS完成方面是成功的。需要进一步的研究来调查这种干预措施对移植后感染的影响。
