药物驱动的快速菌血症反应项目对广谱β -内酰胺酶菌血症成年患者预后的影响：一项回顾性、准实验研究

IF 1.5 Q4 PHARMACOLOGY & PHARMACY Journal of the American College of Clinical Pharmacy : JACCP Pub Date : 2024-12-14 DOI:10.1002/jac5.2063

Elena A. Swingler Pharm.D., MBA, Madison Clark Pharm.D., Sarah E. Moore Pharm.D., Matthew Song Pharm.D., Jamison Montes de Oca Pharm.D., Stephen Furmanek MPH, M.S., Thomas Chandler MPH, Ashley M. Wilde Pharm.D.

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引用次数: 0

摘要

快速诊断技术可以改善患者的治疗效果，特别是与抗菌药物管理计划（ASP）干预相结合时。由于耐药微生物引起的菌血症患者最有可能受益于快速诊断技术，因为他们更有可能得到不充分的经验性治疗。本研究的目的是分析药物驱动的快速菌血症反应计划（RBRP）对由广谱β -内酰胺酶（ESBL）产生的生物体引起的菌血症患者的过程和临床结果的影响。方法在某大型医疗保健系统进行回顾性、准实验研究。RBRP于2017年实施，以加快基于革兰氏染色和Verigene®系统（Luminex Corp, Austin， TX， USA）结果的菌血症抗菌治疗。对ESBL菌血症住院的成人进行干预前和干预后评估（使用RBRP）。主要观察指标为积极治疗的时间。次要结局包括住院和30天死亡率、住院和重症监护病房（ICU）住院时间以及与死亡率相关的因素。结果共纳入200例患者：干预前组100例，干预后组100例。干预后组从血培养收集到积极治疗的时间缩短了6.4小时（干预前22.8小时对干预后16.4小时，p = 0.001）。两组间住院或ICU住院时间、住院或30天死亡率无统计学差异。多变量分析发现，年龄、男性、快速皮特菌血症评分和医院获得性感染与30天死亡率显著相关。结论药物驱动的RBRP可缩短ESBL菌血症患者到积极治疗的时间。

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Effect of a pharmacy-driven rapid bacteremia response program on outcomes in adult patients with extended-spectrum beta-lactamase bacteremia: A retrospective, quasi-experimental study

Introduction

Rapid diagnostic technology can improve patient outcomes, particularly when combined with Antimicrobial Stewardship Program (ASP) intervention. Bacteremic patients due to drug-resistant organisms are most likely to benefit from rapid diagnostic technologies as they are more likely to be prescribed inadequate empiric therapy. The purpose of this study was to analyze the impact of a pharmacy-driven Rapid Bacteremia Response Program (RBRP) on the process and clinical outcomes of patients with bacteremia due to an extended-spectrum beta-lactamase (ESBL)-producing organism.

Methods

A retrospective, quasi-experimental study was conducted at a large healthcare system. The RBRP was implemented in 2017 to expedite antimicrobial therapy for bacteremia based on Gram stain and Verigene® system (Luminex Corp, Austin, TX, USA) results. Adults hospitalized with ESBL bacteremia were evaluated pre-intervention and post-intervention (utilizing the RBRP). The primary outcome was time to active therapy. Secondary outcomes included in-hospital and 30-day mortality, length of hospital and intensive care unit (ICU) stay, and factors associated with mortality.

Results

A total of 200 patients were included: 100 patients in the pre-intervention and 100 patients in the post-intervention group. The post-intervention group resulted in 6.4 h faster time to active therapy from blood culture collection (median 22.8 h pre-intervention vs. 16.4 h post-intervention, p = 0.001). No statistical difference was identified for the length of hospital or ICU stay and in-hospital or 30-day mortality between groups. Multivariable analysis identified age, male sex, quick Pitt bacteremia score, and hospital-acquired infection to be significantly associated with 30-day mortality.