| Autor: |
Uzuriaga M; Clinical Microbiology Service, Clínica Universidad de Navarra, 31008 Pamplona, Spain., Leiva J; Clinical Microbiology Service, Clínica Universidad de Navarra, 31008 Pamplona, Spain.; Healthcare Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain., Guillén-Grima F; Healthcare Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain.; Department of Preventive Medicine, Clínica Universidad de Navarra, 31008 Pamplona, Spain.; CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 46980 Madrid, Spain.; Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain., Rua M; Clinical Microbiology Service, Clínica Universidad de Navarra, 31008 Pamplona, Spain.; Healthcare Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain., Yuste JR; Healthcare Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain.; Service of Infectious Diseases, Clínica Universidad de Navarra, 31008 Pamplona, Spain.; Department of Internal Medicine, Clínica Universidad de Navarra, 31008 Pamplona, Spain. |
| Abstrakt: |
Rapid microbiological reports to clinicians are related to improved clinical outcomes. We conducted a 3-year quasi-experimental design, specifically a pretest-posttest single group design in a university medical center, to evaluate the clinical impact of rapid microbiological identification information using MALDI-TOF MS on optimizing antibiotic prescription. A total of 363 consecutive hospitalized patients with bacterial infections were evaluated comparing a historical control group (CG) (n = 183), in which the microbiological information (bacterial identification and antibiotic susceptibility) was reported jointly to the clinician between 18:00 h and 22:00 h of the same day and a prospective intervention group (IG) (n = 180); the bacterial identification information was informed to the clinician as soon as it was available between 12:00 h and 14:00 h and the antibiotic susceptibility between 18:00 h and 22:00 h). We observed, in favor of IG, a statistically significant decrease in the information time (11.44 h CG vs. 4.48 h IG ( p < 0.01)) from the detection of bacterial growth in the culture medium to the communication of identification. Consequently, the therapeutic optimization was improved by introducing new antibiotics in the 10-24 h time window ( p = 0.05) and conversion to oral route ( p = 0.01). Additionally, we observed a non-statistically significant decrease in inpatient mortality (global, p = 0.15; infection-related, p = 0.21) without impact on hospital length of stay. In conclusion, the rapid communication of microbiological identification to clinicians reduced reporting time and was associated with early optimization of antibiotic prescribing without worsening clinical outcomes. |
