Elda Righi, Alessandro Visentin, Massimo Mirandola, Costanza Rigo, Carmine Cutone, Matilde Rocchi, Lucia Bonato, Maddalena Armellini, Chiara Caletti, Francesco Onorati, Livio San Biagio, Giovanni Battista Luciani, Gina Mazzeo, Mara Merighi, Gianluca Vantini, Alex Borin, Luigino Boschiero, Amedeo Carraro, Evelina Tacconelli
{"title":"改进实体器官移植候选者感染筛查的数字化方法。","authors":"Elda Righi, Alessandro Visentin, Massimo Mirandola, Costanza Rigo, Carmine Cutone, Matilde Rocchi, Lucia Bonato, Maddalena Armellini, Chiara Caletti, Francesco Onorati, Livio San Biagio, Giovanni Battista Luciani, Gina Mazzeo, Mara Merighi, Gianluca Vantini, Alex Borin, Luigino Boschiero, Amedeo Carraro, Evelina Tacconelli","doi":"10.1111/ctr.15408","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Pretransplant infection screening (IS) of potential organ recipients is essential to optimal outcome of solid organ transplantation (SOT).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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, <i>p</i> < 0.001) with significant improvement recorded for seven (39%) IS items. Unnecessary tests decreased by 43% after the intervention. ID consultation (IRR 1.13, <i>p</i> = 0.02) and urgent evaluation (<i>p</i> = 0.68, <i>p</i> < 0.001) were predictors of IS improvement.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>STREAM was successful in improving IS completion. 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引用次数: 0
摘要
背景：对潜在器官受者进行移植前感染筛查（IS）对实体器官移植（SOT）的最佳结果至关重要：方法：2020-2023年期间进行了一项前后期研究，以调查STREAM（实体器官移植手术和多学科方法）干预对改善SOT感染筛查的影响。干预措施于 2022 年实施，包括通过教育会议、地方指南和提供数字筛查工具来实施 IS。研究的目的是评估 IS 的完成情况，包括 17 项实验室检查和疫苗接种情况调查。此外，还对减少不必要检查的情况进行了分析。研究采用了比例检验和多层次多变量泊松回归模型来比较 STREAM 使用前后的 IS 完成情况，并将传染病（ID）咨询和紧急评估作为 IS 完成情况的预测因素进行了调查：共有 171 名患者入组，包括肝脏（44%）、心脏（32%）和肾脏（24%）移植候选者。平均年龄为 56 ± 11 岁，大多数患者（77%）为男性。干预前纳入了 95 名患者（56%），STREAM 后纳入了 76 名患者（44%）。STREAM 后，IS 完成率有所提高（IRR 1.41，p < 0.001），其中 7 项（39%）IS 项目的完成率显著提高。干预后，不必要的检查减少了 43%。ID咨询（IRR 1.13，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 成功改善了 IS 的完成情况。结论：STREAM 成功地提高了 IS 的完成率，需要进一步研究这种干预措施对移植后感染的影响。
A Digital Approach to Improve Infection Screening Among Solid Organ Transplant Candidates
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.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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