Julian Ventres, Michelle H Ting, Diane M Parente, Ralph Rogers, Ashlyn M Norris, Gregorio Benitez, Fadi Shehadeh, April M Bobenchik, Eleftherios Mylonakis, Kimberle C Chapin, Cheston B Cunha
{"title":"革兰氏阴性菌血症的快速诊断分析与抗菌药物管理干预相结合","authors":"Julian Ventres, Michelle H Ting, Diane M Parente, Ralph Rogers, Ashlyn M Norris, Gregorio Benitez, Fadi Shehadeh, April M Bobenchik, Eleftherios Mylonakis, Kimberle C Chapin, Cheston B Cunha","doi":"10.1093/ofid/ofae477","DOIUrl":null,"url":null,"abstract":"Background Traditional blood cultures for gram-negative bacteremia can take up to 72 hours or more to return results, prolonging the duration of empiric broad-spectrum intravenous antibiotics. The Accelerate Pheno® system provides rapid identification and susceptibilities for blood cultures in gram-negative bacteremia. Current data on its clinical utility is mixed overall and requires further research. Methods A multi-center, retrospective quasi-experimental study was conducted comparing the Accelerate Pheno® rapid diagnostic system with antimicrobial stewardship intervention and traditional blood cultures alone. Results A total of 264 patients with blood cultures with gram-negative bacteria growth were included in the final analysis (102 pre-intervention, 162 post-intervention). The antimicrobial stewardship team made 364 recommendations in 152/162 (93.8%) patients in the post-group. Duration of intravenous therapy was shorter (p<0.001) for the post-intervention group (median 4.0 days) compared to the pre-intervention group (median 7.5 days). Hospital length of stay was also shorter (p<0.001) for the post-intervention group (median 5.1 days) compared to the pre-intervention group (median 7.0 days). Readmission rates within 30 days were reduced (p=0.042) post-intervention (13.0%) compared to pre-intervention (22.6%). In the post-intervention group, a larger proportion of patients were transitioned to oral therapy at any point (126/162, 77.8%) compared to pre-intervention (62/102, 60.8%) (p<0.001). Conclusions These results suggest that the Accelerate Pheno® with active review and intervention by a multidisciplinary antimicrobial stewardship team is a useful tool in improving both patient-centric and antimicrobial stewardship outcomes.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":3.8000,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Combination of a Rapid Diagnostic Assay and Antimicrobial Stewardship Intervention on Gram-negative Bacteremia\",\"authors\":\"Julian Ventres, Michelle H Ting, Diane M Parente, Ralph Rogers, Ashlyn M Norris, Gregorio Benitez, Fadi Shehadeh, April M Bobenchik, Eleftherios Mylonakis, Kimberle C Chapin, Cheston B Cunha\",\"doi\":\"10.1093/ofid/ofae477\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background Traditional blood cultures for gram-negative bacteremia can take up to 72 hours or more to return results, prolonging the duration of empiric broad-spectrum intravenous antibiotics. The Accelerate Pheno® system provides rapid identification and susceptibilities for blood cultures in gram-negative bacteremia. Current data on its clinical utility is mixed overall and requires further research. Methods A multi-center, retrospective quasi-experimental study was conducted comparing the Accelerate Pheno® rapid diagnostic system with antimicrobial stewardship intervention and traditional blood cultures alone. Results A total of 264 patients with blood cultures with gram-negative bacteria growth were included in the final analysis (102 pre-intervention, 162 post-intervention). The antimicrobial stewardship team made 364 recommendations in 152/162 (93.8%) patients in the post-group. Duration of intravenous therapy was shorter (p<0.001) for the post-intervention group (median 4.0 days) compared to the pre-intervention group (median 7.5 days). Hospital length of stay was also shorter (p<0.001) for the post-intervention group (median 5.1 days) compared to the pre-intervention group (median 7.0 days). Readmission rates within 30 days were reduced (p=0.042) post-intervention (13.0%) compared to pre-intervention (22.6%). In the post-intervention group, a larger proportion of patients were transitioned to oral therapy at any point (126/162, 77.8%) compared to pre-intervention (62/102, 60.8%) (p<0.001). Conclusions These results suggest that the Accelerate Pheno® with active review and intervention by a multidisciplinary antimicrobial stewardship team is a useful tool in improving both patient-centric and antimicrobial stewardship outcomes.\",\"PeriodicalId\":19517,\"journal\":{\"name\":\"Open Forum Infectious Diseases\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2024-08-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open Forum Infectious Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ofid/ofae477\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Forum Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ofid/ofae477","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
Combination of a Rapid Diagnostic Assay and Antimicrobial Stewardship Intervention on Gram-negative Bacteremia
Background Traditional blood cultures for gram-negative bacteremia can take up to 72 hours or more to return results, prolonging the duration of empiric broad-spectrum intravenous antibiotics. The Accelerate Pheno® system provides rapid identification and susceptibilities for blood cultures in gram-negative bacteremia. Current data on its clinical utility is mixed overall and requires further research. Methods A multi-center, retrospective quasi-experimental study was conducted comparing the Accelerate Pheno® rapid diagnostic system with antimicrobial stewardship intervention and traditional blood cultures alone. Results A total of 264 patients with blood cultures with gram-negative bacteria growth were included in the final analysis (102 pre-intervention, 162 post-intervention). The antimicrobial stewardship team made 364 recommendations in 152/162 (93.8%) patients in the post-group. Duration of intravenous therapy was shorter (p<0.001) for the post-intervention group (median 4.0 days) compared to the pre-intervention group (median 7.5 days). Hospital length of stay was also shorter (p<0.001) for the post-intervention group (median 5.1 days) compared to the pre-intervention group (median 7.0 days). Readmission rates within 30 days were reduced (p=0.042) post-intervention (13.0%) compared to pre-intervention (22.6%). In the post-intervention group, a larger proportion of patients were transitioned to oral therapy at any point (126/162, 77.8%) compared to pre-intervention (62/102, 60.8%) (p<0.001). Conclusions These results suggest that the Accelerate Pheno® with active review and intervention by a multidisciplinary antimicrobial stewardship team is a useful tool in improving both patient-centric and antimicrobial stewardship outcomes.
期刊介绍:
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.