目的:革兰阴性菌(GNB)是血流感染(BSI)的主要原因,管理复杂,抗生素耐药性。AcceleratePheno™系统(ACC)可提供快速的生物体鉴定和抗微生物药敏试验(AST)。
方法:回顾性研究,我们进行了干预前/干预后研究,比较了非危重患者在实施捆绑计划前后对GNBBSI的管理.这项捆绑的计划包括传播临床决策算法,对从血液培养物中分离出的所有GNB进行ACC测试,将结果实时传达给抗菌药物管理计划(ASP),以及ASP反馈的前瞻性审计。干预前为2018年1月至2018年12月,干预后为2019年5月至2020年2月。
结果:77和129名患者被纳入干预前和干预后队列,分别。与干预前相比,从革兰氏染色到AST的时间从46.1小时减少到6.9小时(p<0.001),最终治疗时间(TTDT)从32.6小时提高到10.5小时(p<0.001)。实施抗生素治疗的中位总持续时间(14.2vs9.5天;p<0.001)和平均住院时间(7.9vs5.3天;p=0.047)较短,而30天的再入院率没有增加(22.1%vs14%;p=0.13)。
结论:实施包含ACC的ASP捆绑方法,旨在优化非危重患者GNBBSI管理中的抗生素治疗,可降低TTDT,抗生素治疗持续时间较短,缩短住院时间,而不会对再入院率产生不利影响。
OBJECTIVE: Gram-negative bacteria (GNB) are a leading cause of bloodstream infections (BSI) and management is complicated by antibiotic resistance. The Accelerate Pheno™ system (ACC) can provide rapid organism identification and antimicrobial susceptibility testing (AST).
METHODS: A retrospective, pre-intervention/post-intervention study was conducted to compare management of non-critically ill patients with GNB BSI before and after implementation of a bundled initiative. This bundled initiative included dissemination of a clinical decision algorithm, ACC testing on all GNB isolated from blood cultures, real-time communication of results to the Antimicrobial Stewardship Program (ASP), and prospective audit with feedback by the ASP. The pre-intervention period was January 2018 through December 2018, and the post-intervention period was May 2019 through February 2020.
RESULTS: Seventy-seven and 129 patients were included in the pre-intervention and post-intervention cohorts, respectively. When compared with the pre-intervention group, the time from Gram stain to AST decreased from 46.1 to 6.9 h (p < 0.001), and the time to definitive therapy (TTDT) improved from 32.6 to 10.5 h (p < 0.001). Implementation led to shorter median total duration of antibiotic therapy (14.2 vs 9.5 days; p < 0.001) and mean hospital length of stay (7.9 vs 5.3 days; p = 0.047) without an increase in 30-day readmissions (22.1% vs 14%; p = 0.13).
CONCLUSIONS: Implementation of an ASP-bundled approach incorporating the ACC aimed at optimizing antibiotic therapy in the management GNB BSI in non-critically ill patients led to reduced TTDT, shorter duration of antibiotic therapy, and shorter hospital length of stay without adversely affecting readmission rates.