Guillermo Martín-Gutiérrez, José Molina, Carlos Martín-Pérez, Manuela Aguilar-Guisado, María Solla, Belén Ramos-Morán, Teresa Aldabó, Rosario Amaya-Villar, Adelina Gimeno, Pilar Egea, Rocío Álvarez-Marín, José Antonio Lepe, José Miguel Cisneros
{"title":"西班牙三级医院重症感染早期诊断和治疗综合方案的制定。","authors":"Guillermo Martín-Gutiérrez, José Molina, Carlos Martín-Pérez, Manuela Aguilar-Guisado, María Solla, Belén Ramos-Morán, Teresa Aldabó, Rosario Amaya-Villar, Adelina Gimeno, Pilar Egea, Rocío Álvarez-Marín, José Antonio Lepe, José Miguel Cisneros","doi":"10.1093/ofid/ofaf532","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>To assess the impact of the rapid diagnosis and treatment of severe infections (rDTSI) program on diagnostic and clinical outcomes in patients with severe infections.</p><p><strong>Method: </strong>We conducted a pre-post quasi-experimental study evaluating patients with severe pneumonia or sepsis before (October 2019-February 2020) and after (March 2022-March 2023) rDTSI implementation. The program integrated rapid molecular diagnostics, a 24/7 laboratory workflow, and multidisciplinary training. Primary outcomes included time from clinical diagnosis to pathogen-directed therapy and targeted therapy within 48 h. Secondary outcomes assessed antimicrobial appropriateness (DOOR-MAT), length of stay, and mortality.</p><p><strong>Results: </strong>The rDTSI program significantly reduced the median time to pathogen-directed therapy in pneumonia (48.8 vs 23.6 h, <i>P</i> < .001) and increased targeted therapy within 48 h (36.17% to 58.14%, <i>P</i> = .049). Hospital stays decreased (38.9 to 22.2 days, <i>P</i> < .001). In sepsis, diagnostic times (19.4 vs 18.1 h, <i>P</i> = .028) and DOOR-MAT scores (80.4 vs 88.0, <i>P</i> = .024) improved, while other clinical outcomes remained unchanged.</p><p><strong>Conclusions: </strong>The rDTSI program accelerated microbiological diagnosis, optimized antimicrobial therapy, and improved hospital efficiency in severe infections. These findings support integrating rapid diagnostics into antimicrobial stewardship programs to enhance severe infection management.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf532"},"PeriodicalIF":3.8000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448488/pdf/","citationCount":"0","resultStr":"{\"title\":\"Development of a Comprehensive Program for the Early Diagnosis and Treatment of Severe Infections in a Tertiary Hospital in Spain.\",\"authors\":\"Guillermo Martín-Gutiérrez, José Molina, Carlos Martín-Pérez, Manuela Aguilar-Guisado, María Solla, Belén Ramos-Morán, Teresa Aldabó, Rosario Amaya-Villar, Adelina Gimeno, Pilar Egea, Rocío Álvarez-Marín, José Antonio Lepe, José Miguel Cisneros\",\"doi\":\"10.1093/ofid/ofaf532\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>To assess the impact of the rapid diagnosis and treatment of severe infections (rDTSI) program on diagnostic and clinical outcomes in patients with severe infections.</p><p><strong>Method: </strong>We conducted a pre-post quasi-experimental study evaluating patients with severe pneumonia or sepsis before (October 2019-February 2020) and after (March 2022-March 2023) rDTSI implementation. The program integrated rapid molecular diagnostics, a 24/7 laboratory workflow, and multidisciplinary training. Primary outcomes included time from clinical diagnosis to pathogen-directed therapy and targeted therapy within 48 h. Secondary outcomes assessed antimicrobial appropriateness (DOOR-MAT), length of stay, and mortality.</p><p><strong>Results: </strong>The rDTSI program significantly reduced the median time to pathogen-directed therapy in pneumonia (48.8 vs 23.6 h, <i>P</i> < .001) and increased targeted therapy within 48 h (36.17% to 58.14%, <i>P</i> = .049). Hospital stays decreased (38.9 to 22.2 days, <i>P</i> < .001). In sepsis, diagnostic times (19.4 vs 18.1 h, <i>P</i> = .028) and DOOR-MAT scores (80.4 vs 88.0, <i>P</i> = .024) improved, while other clinical outcomes remained unchanged.</p><p><strong>Conclusions: </strong>The rDTSI program accelerated microbiological diagnosis, optimized antimicrobial therapy, and improved hospital efficiency in severe infections. These findings support integrating rapid diagnostics into antimicrobial stewardship programs to enhance severe infection management.</p>\",\"PeriodicalId\":19517,\"journal\":{\"name\":\"Open Forum Infectious Diseases\",\"volume\":\"12 9\",\"pages\":\"ofaf532\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448488/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open Forum Infectious Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ofid/ofaf532\",\"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/ofaf532","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：评估重症感染快速诊断与治疗（rDTSI）项目对重症感染患者诊断和临床结局的影响。方法：我们在实施rDTSI之前（2019年10月- 2020年2月）和之后（2022年3月- 2023年3月）对严重肺炎或脓毒症患者进行了前后准实验研究。该项目整合了快速分子诊断、24/7实验室工作流程和多学科培训。主要结局包括从临床诊断到病原体定向治疗和靶向治疗48小时内的时间。次要结局评估抗菌素适宜性（DOOR-MAT）、住院时间和死亡率。结果：rDTSI方案显著缩短了肺炎患者进行病原体定向治疗的中位时间（48.8 h vs 23.6 h, P < 0.001），并增加了48 h内的靶向治疗时间（36.17% vs 58.14%, P = 0.049）。住院时间缩短（38.9 ~ 22.2天，P < 0.001）。脓毒症的诊断时间（19.4 vs 18.1 h, P = 0.028）和DOOR-MAT评分（80.4 vs 88.0, P = 0.024）均有改善，而其他临床结果保持不变。结论：rDTSI项目加速了微生物学诊断，优化了抗菌药物治疗，提高了严重感染的医院效率。这些发现支持将快速诊断纳入抗菌药物管理规划，以加强严重感染管理。
Development of a Comprehensive Program for the Early Diagnosis and Treatment of Severe Infections in a Tertiary Hospital in Spain.
Background: To assess the impact of the rapid diagnosis and treatment of severe infections (rDTSI) program on diagnostic and clinical outcomes in patients with severe infections.
Method: We conducted a pre-post quasi-experimental study evaluating patients with severe pneumonia or sepsis before (October 2019-February 2020) and after (March 2022-March 2023) rDTSI implementation. The program integrated rapid molecular diagnostics, a 24/7 laboratory workflow, and multidisciplinary training. Primary outcomes included time from clinical diagnosis to pathogen-directed therapy and targeted therapy within 48 h. Secondary outcomes assessed antimicrobial appropriateness (DOOR-MAT), length of stay, and mortality.
Results: The rDTSI program significantly reduced the median time to pathogen-directed therapy in pneumonia (48.8 vs 23.6 h, P < .001) and increased targeted therapy within 48 h (36.17% to 58.14%, P = .049). Hospital stays decreased (38.9 to 22.2 days, P < .001). In sepsis, diagnostic times (19.4 vs 18.1 h, P = .028) and DOOR-MAT scores (80.4 vs 88.0, P = .024) improved, while other clinical outcomes remained unchanged.
Conclusions: The rDTSI program accelerated microbiological diagnosis, optimized antimicrobial therapy, and improved hospital efficiency in severe infections. These findings support integrating rapid diagnostics into antimicrobial stewardship programs to enhance severe infection management.
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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
