The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial

Autor: Cristhieni Rodrigues, Rinaldo Focaccia Siciliano, Helio Caiaffa Filho, Cecília Eugenia Charbel, Luciane de Carvalho Sarahyba da Silva, Martina Baiardo Redaelli, Ana Paula de Paula Rosa Passetti, Maria Renata Gomes Franco, Flávia Rossi, Rogerio Zeigler, Daniel De Backer, Rafael Alves Franco, Juliano Pinheiro de Almeida, Stéphanie Itala Rizk, Julia Tizue Fukushima, Giovanni Landoni, David Everson Uip, Ludhmila Abrahão Hajjar, Tania Mara Varejão Strabelli
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: Journal of Intensive Care, Vol 7, Iss 1, Pp 1-9 (2019)
Druh dokumentu: article
ISSN: 2052-0492
DOI: 10.1186/s40560-019-0391-3
Popis: Abstract Background Appropriate use of antimicrobials is essential to improve outcomes in sepsis. The aim of this study was to determine whether the use of a rapid molecular blood test—SeptiFast (SF) reduces the antibiotic consumption through early de-escalation in patients with nosocomial sepsis compared with conventional blood cultures (BCs). Methods This was a prospective, randomized, superiority, controlled trial conducted at Sao Paulo Heart Institute in the period October 2012–May 2016. Adult patients admitted to the hospital for at least 48 h with a diagnosis of nosocomial sepsis underwent microorganism identification by both SF test and BCs. Patients randomized into the intervention group received antibiotic therapy adjustment according to the results of SF. Patients randomized into the control group received standard antibiotic adjustment according to the results of BCs. The primary endpoint was antimicrobial consumption during the first 14 days after randomization. Results A total of 200 patients were included (100 in each group). The intention to treat analysis found no significant differences in median antibiotic consumption. In the subgroup of patients with positive SF and blood cultures (19 and 25 respectively), we found a statistically significant reduction in the median antimicrobial consumption which was 1429 (1071–2000) days of therapy (DOT)/1000 patients-day in the intervention group and 1889 (1357–2563) DOT/1000 patients-day in the control group (p = 0.017), in the median time of antimicrobial de-escalation (8 versus 54 h—p
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