Fast track SSTI management program based on a rapid molecular test (GeneXpert® MRSA/SA SSTI) and antimicrobial stewardship

Autor: Luis Alcalá, María Auxiliadora Semiglia-Chong, Almudena Burillo, Ana Álvarez-Uría, Raffaella Onori, Emilio Bouza
Rok vydání: 2020
Předmět:
Male
Microbiological Techniques
0301 basic medicine
Antibiotics
lcsh:QR1-502
lcsh:Microbiology
law.invention
Cohort Studies
Antimicrobial Stewardship
0302 clinical medicine
law
Immunology and Allergy
Antimicrobial stewardship
Prospective Studies
030212 general & internal medicine
Skin
Aged
80 and over
GeneXpert MTB/RIF
General Medicine
Middle Aged
Staphylococcal Infections
Clostridium difficile
Abscess
Diabetic Foot
Hospitals
Anti-Bacterial Agents
Infectious Diseases
Gram staining
Molecular Diagnostic Techniques
Cellulitis
Cohort
Female
Algorithms
Methicillin-Resistant Staphylococcus aureus
Microbiology (medical)
Staphylococcus aureus
medicine.medical_specialty
medicine.drug_class
030106 microbiology
03 medical and health sciences
Internal medicine
medicine
Humans
Aged
General Immunology and Microbiology
business.industry
Soft Tissue Infections
medicine.disease
Diabetic foot
business
Zdroj: Journal of Microbiology, Immunology and Infection, Vol 53, Iss 2, Pp 328-335 (2020)
ISSN: 1684-1182
DOI: 10.1016/j.jmii.2018.07.008
Popis: Purpose: This study examines the impacts of a skin and soft tissue infection (SSTI) management program involving a rapid diagnostic algorithm (Gram stain plus real-time PCR, GeneXpert® MRSA/SA SSTI) performed directly on clinical samples plus antimicrobial stewardship (AMS) counseling of the responsible physician. Methods: Participants were 155 consecutive adult inpatients with SSTI and good quality clinical samples submitted to the microbiology laboratory from April 2016 to January 2017. Results of the rapid test and AMS recommendations were phoned through to the responsible physician. The comparison group was a historical cohort. Results: Most SSTI were surgical wound infections (41.3% vs 38.1% for the intervention and comparison groups respectively) followed by diabetic foot (14.2% and 18.1%), abscesses (13.5% both) and cellulitis (12.9% both). Isolated microorganisms were mostly Gram-negative bacilli (two-thirds), followed by Staphylococcus aureus (SA). The ratio methicillin-susceptible SA (MSSA) to methicillin-resistant SA (MRSA) was 4:1. Improvements in the intervention cohort were: DOT (22.0 vs. 24.3 days, p = 0.007), treatment duration per SSTI episode (14.1 vs. 15.0 days, p = 0.072), treatment cost (433.1 vs. 533.3 €, p = 0.039), length of stay (18.6 vs 20.7 days, p = 0.031), related mortality (1 vs. 4 patients, p = 0.022) and Clostridium difficile infection (CDI) (4 vs. 8 patients, p = 0.050). In 48 cases (31.4%) in the intervention group, advice was given to improve empiric antibiotic treatment. Conclusion: This type of program could help adjust antibiotic treatment when inappropriate, reducing antibiotic use and costs, length of stay, CDI and related mortality. Keywords: Antimicrobial stewardship, GeneXpert® MRSA/SA SSTI, Microbiological techniques, Rapid diagnosis, Soft tissue infections
Databáze: OpenAIRE
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