An Antimicrobial Stewardship Program's Impact with Rapid Polymerase Chain Reaction Methicillin- Resistant Staphylococcus aureus/S. aureus Blood Culture Test in Patients with S. aureus Bacteremia
An Antimicrobial Stewardship Program's Impact with Rapid Polymerase Chain Reaction Methicillin- Resistant Staphylococcus aureus/S. aureus Blood Culture Test in Patients with S. aureus Bacteremia
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DOI：
10.1086/656623
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发表时间：
2010-11-01
影响因子：
11.8
通讯作者：
Goff, Debra A.
中科院分区：
文献类型：
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作者：
Bauer, Karri A.;West, Jessica E.;Goff, Debra A.
金黄色葡萄球菌菌血症的快速微生物检测和与临床医生的沟通加速了抗生素的优化。我们评估了快速聚合酶链反应耐甲氧西林链球菌的临床和经济结果。金黄色葡萄球菌/S.金黄色葡萄球菌血培养试验（rPCR）。这项单中心研究比较了住院患者与S。2008年9月1日至2008年12月31日（rPCR前）和2009年3月10日至2009年6月30日（rPCR后）收治的金黄色葡萄球菌菌血症患者。将rPCR结果与传染病药剂师联系;建议使用有效的抗生素和进行传染病咨询。多变量回归评估了156例患者的临床和经济结局。甲氧西林敏感链球菌患者从经验性万古霉素转换为头孢唑林或萘夫西林的平均时间。rPCR后金黄色葡萄球菌菌血症缩短1.7天（P = .002）。在rPCR后甲氧西林敏感和耐药的S。金黄色葡萄球菌组，平均住院时间缩短6.2天（P = 0.07），平均住院费用减少21，387美元（P = 0.02）。rPCR可快速区分S.金黄色葡萄球菌菌血症，使及时，有效的治疗，并与缩短住院时间和医疗保健费用。
Rapid organism detection of Staphylococcus aureus bacteremia and communication to clinicians expedites antibiotic optimization. We evaluated clinical and economic outcomes of a rapid polymerase chain reaction methicillin-resistant S. aureus/S. aureus blood culture test (rPCR). This single-center study compared inpatients with S. aureus bacteremia admitted from 1 September 2008 through 31 December 2008 (pre-rPCR) and those admitted from 10 March 2009 through 30 June 2009 (post-rPCR). An infectious diseases pharmacist was contacted with results of the rPCR; effective antibiotics and an infectious diseases consult were recommended. Multivariable regression assessed clinical and economic outcomes of the 156 patients. Mean time to switch from empiric vancomycin to cefazolin or nafcillin in patients with methicillin-susceptible S. aureus bacteremia was 1.7 days shorter post-rPCR (P = .002). In the post-rPCR methicillin-susceptible and methicillin-resistant S. aureus groups, the mean length of stay was 6.2 days shorter (P = .07) and the mean hospital costs were $ 21,387 less (P = .02). rPCR allows rapid differentiation of S. aureus bacteremia, enabling timely, effective therapy and is associated with decreased length of stay and health care costs.