Int J Antimicrob Agents. 2022;60(1):106604.
Effectiveness of antimicrobial stewardship programmes based on rapid antibiotic susceptibility testing of haematological patients having high-risk factors for bacteraemia-related mortality: a post-hoc analysis of a randomised controlled trial.
제1저자 김정한, 김택수 · 교신저자 박완범, 김인호
소속 (4)
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea.
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea. Electronic address: wbpark1@snu.ac.kr.
- Division of Haematology-Oncology, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea. Electronic address: ihkimmd@snu.ac.kr.
Abstract
A randomised controlled trial showed that rapid phenotypic antibiotic susceptibility testing (AST) with antimicrobial stewardship programme (ASP) increases the proportion of haematological patients with bacteraemia receiving optimal targeted therapy within 72 h of blood culture collection. This post-hoc analysis aimed to evaluate the effects of rapid phenotypic AST intervention in haematological patients at high risk of a poor outcome from bacteraemia. Haematological patients with bacteraemia (n = 116) were assigned randomly to a conventional AST group or a rapid AST group. The two outcome measures were the proportion of patients receiving optimal targeted therapy at 72 h post blood culture collection and the time to optimal targeted therapy; subgroup analysis was conducted based on baseline demographics (age, sex) and prognostic (Charlson comorbidity index, haematological treatment intensity, Pitt bacteraemia score, appropriateness of empirical antibiotic therapy and multidrug-resistant organism) indicators. The interaction effect between the intervention and subgroup factors was examined using regression model analysis. Age, sex, Charlson comorbidity index, haematological treatment intensity, Pitt bacteraemia score and appropriateness of empirical antibiotic therapy had no significant interaction effects on the proportion of patients receiving optimal targeted therapy (P = 0.129-0.826). However, infection by a multidrug-resistant organism did have a significant interaction effect (P = 0.042). Regarding time to optimal targeted therapy, there were no significant interaction effects between the intervention and subgroup factors (P = 0.156-0.848). In conclusion, rapid phenotypic AST with ASP intervention may accelerate early optimal targeted antimicrobial treatment of haematological patients, even those in high-risk subgroups with bacteraemia.
Copyright © 2022 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.
Keywords
Antibiotic susceptibility testingAntimicrobial stewardship programmeBacteraemiaHigh-risk haematological patientRapid diagnostic test
그 밖의 정보
- 출판 형태
- Journal Article, Randomized Controlled Trial
- 저널
- International journal of antimicrobial agents · eISSN 1872-7913
- 전자 출판
- 2022-05-17
- MeSH
- Anti-Bacterial Agents / pharmacology / therapeutic use · Antimicrobial Stewardship* · Bacteremia* / drug therapy · Blood Culture · Enterococcus · Humans · Risk Factors
- Substances
- Anti-Bacterial Agents