Reduced mortality with antimicrobial stewardship guided by BioFire FilmArray Blood Culture Identification 2 panel in critically ill patients with bloodstream infection: A retrospective propensity score-matched study

IF 4.9 2区 医学 Q1 INFECTIOUS DISEASES
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Abstract

Objectives

To investigate whether using the BioFire® FilmArray® Blood Culture Identification 2 panel (BCID2) leads to timely antimicrobial therapy and improves patient outcomes in critically ill patients with bloodstream infections (BSIs).

Methods

This retrospective observational study included patients with BSIs admitted to the intensive care unit from July 1, 2021, to August 31, 2023. Patients were divided into groups receiving appropriate or inappropriate antimicrobial therapy. Those receiving inappropriate therapy underwent adjustments using standard-of-care (SOC) testing or BCID2. Propensity score matching (PSM) was performed on the original cohort (Model 1) and a time-window bias-adjusted cohort (Model 2). Clinical impact of BCID2-guided antimicrobial adjustment was analysed in both models.

Results

A total of 181 patients received inappropriate antimicrobial therapy, with 33 undergoing BCID2 testing and 148 undergoing SOC testing. Following PSM and time-window bias adjustment, 66 patients were analysed in Model 1 and 46 patients in Model 2. BCID2 significantly reduced the median time to appropriate antimicrobial therapy (40.8 vs. 74.0 h in Model 1; 42.8 vs. 68.9 h in Model 2) and the day-28 mortality rate (27.8% vs. 77.1%, P < 0.001 in Model 1; 23.5% vs. 58.6%, P = 0.021 in Model 2). In multivariate regression analysis, BCID2-guided antimicrobial adjustment was an independent prognostic factor for day-28 mortality (adjusted odds ratio [aOR] 0.07 in Model 1 and aOR 0.12 in Model 2).

Conclusion

BCID2-guided antimicrobial stewardship was associated with a shorter time to appropriate antimicrobial therapy and reduced day-28 mortality in critically ill patients with BSIs receiving inappropriate antimicrobial therapy.

Abstract Image

以 BioFire FilmArray 血液培养鉴定 2 小组为指导,降低血流感染重症患者的抗菌药物管理死亡率:一项倾向得分匹配的回顾性研究。
目的研究使用 BioFire® FilmArray® 血液培养鉴定 2 小组(BCID2)是否能及时进行抗菌治疗并改善血液感染(BSI)重症患者的预后:这项回顾性观察研究纳入了 2021 年 7 月 1 日至 2023 年 8 月 31 日期间入住重症监护病房的 BSI 患者。患者被分为接受适当或不适当抗菌治疗的两组。接受不恰当治疗的患者将通过护理标准(SOC)检测或 BCID2 进行调整。对原始队列(模型1)和经过时间窗偏倚调整的队列(模型2)进行倾向得分匹配(PSM)。两个模型均分析了在 BCID2 指导下调整抗菌药物对临床的影响:共有 181 名患者接受了不恰当的抗菌治疗,其中 33 人接受了 BCID2 检测,148 人接受了 SOC 检测。经过PSM和时间窗偏差调整后,模型1分析了66名患者,模型2分析了46名患者。BCID2 显著缩短了适当抗菌治疗的中位时间(模型 1 中为 40.8 小时 vs. 74.0 小时;模型 2 中为 42.8 小时 vs. 68.9 小时)和第 28 天死亡率(模型 1 中为 27.8% vs. 77.1%,p < 0.001;模型 2 中为 23.5% vs. 58.6%,p = 0.021)。在多变量回归分析中,BCID2指导下的抗菌药物调整是第28天死亡率的独立预后因素(模型1中调整后的几率比[aOR]为0.07,模型2中调整后的几率比[aOR]为0.12):结论:BCID2-指导下的抗菌药物管理与缩短接受适当抗菌药物治疗的时间和降低接受不适当抗菌药物治疗的BSI重症患者的第28天死亡率有关。
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来源期刊
CiteScore
21.60
自引率
0.90%
发文量
176
审稿时长
36 days
期刊介绍: The International Journal of Antimicrobial Agents is a peer-reviewed publication offering comprehensive and current reference information on the physical, pharmacological, in vitro, and clinical properties of individual antimicrobial agents, covering antiviral, antiparasitic, antibacterial, and antifungal agents. The journal not only communicates new trends and developments through authoritative review articles but also addresses the critical issue of antimicrobial resistance, both in hospital and community settings. Published content includes solicited reviews by leading experts and high-quality original research papers in the specified fields.
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