Does PCR-based pathogen identification reduce mortality in bloodstream infections? Insights from a difference-in-difference analysis.

IF 3 4区 医学 Q2 INFECTIOUS DISEASES
Juan Gago, Audrey Renson, Courtney Takats, Victor J Torres, Bo Shopsin, Lorna E Thorpe
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Abstract

Background: Bloodstream infections (BSI) are associated with high mortality rates, particularly when caused by resistant pathogens. Reducing the delay in diagnosis and initiation of appropriate treatment is crucial for improving clinical outcomes. The implementation of polymerase chain reaction (PCR) tests in the diagnostic process offers a promising approach to achieving quicker identification of pathogens, thereby potentially reducing mortality associated with BSI.

Methods: A difference-in-differences analysis was performed within a New York City hospital system, comparing mortality risk between patients with enterococcal BSI before and after the adoption of BCID2 PCR testing, using as control those with methicillin-sensitive S. aureus BSI, for which diagnostic protocol has been unchanged.

Results: The study included 548 inpatients; 164 diagnosed with vancomycin-resistant enterococci (VRE) BSI and 384 with MSSA BSI. The mean 30-day mortality risk difference in the period post-intervention estimated in our difference-in-differences model was -6.03 per 100 (95% CI: -10.35 to -1.7), with event study plots suggesting minimal deviation from parallel trends in the pre-treatment period.

Conclusions: Findings suggest that introduction of BCID2 PCR testing for enterococcal bloodstream infections (BSI) may be associated with a reduction in mortality, however, interpretation of the effects must be approached with caution given the relative imprecision of estimates. Further research with larger samples is essential to establish a definitive conclusion on the impact of rapid PCR testing on mortality in BSI. This is an innovative approach using causal methods to evaluate interventions aimed at the improvement of infection control and antimicrobial treatment strategies.

基于pcr的病原体鉴定能降低血液感染的死亡率吗?从差异分析中得出的见解。
背景:血液感染(BSI)与高死亡率相关,特别是当由耐药病原体引起时。减少诊断延误和开始适当治疗对改善临床结果至关重要。在诊断过程中实施聚合酶链反应(PCR)试验为更快地识别病原体提供了一种有希望的方法,从而有可能降低与BSI相关的死亡率。方法:在纽约市医院系统内进行差异中差异分析,比较采用bid2 PCR检测前后肠球菌BSI患者的死亡风险,并将诊断方案未改变的甲氧西林敏感金黄色葡萄球菌BSI患者作为对照。结果:纳入住院患者548例;164例诊断为万古霉素耐药肠球菌(VRE) BSI, 384例诊断为MSSA BSI。在我们的差中差模型中估计,干预后期间的平均30天死亡率风险差异为-6.03 / 100 (95% CI: -10.35至-1.7),事件研究图显示与治疗前期间的平行趋势偏差最小。结论:研究结果表明,引入肠球菌血液感染(BSI)的bid2 PCR检测可能与死亡率的降低有关,然而,考虑到估计的相对不精确,必须谨慎解释其影响。为了就快速聚合酶链反应检测对BSI死亡率的影响得出明确的结论,必须对更大样本进行进一步研究。这是一种创新的方法,使用因果方法来评估旨在改善感染控制和抗微生物治疗策略的干预措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.40
自引率
6.70%
发文量
289
审稿时长
3-8 weeks
期刊介绍: Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. Written by infection control practitioners and epidemiologists and guided by an editorial board composed of the nation''s leaders in the field, ICHE provides a critical forum for this vital information.
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