Implementation of Point-of-Care Molecular Diagnostics for Mycoplasma pneumoniae Ensures the Correct Antimicrobial Prescription for Pediatric Pneumonia Patients
Implementation of Point-of-Care Molecular Diagnostics for Mycoplasma pneumoniae Ensures the Correct Antimicrobial Prescription for Pediatric Pneumonia Patients
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DOI：
10.1620/tjem.246.225
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发表时间：
2018-12-01
影响因子：
2.2
通讯作者：
Imai, Hironori
中科院分区：
文献类型：
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作者：
Hayashi, Daisuke;Akashi, Yusaku;Imai, Hironori
肺炎支原体是儿科肺炎的主要病原体，其准确的诊断有助于选择合适的抗菌药物。我们建立了肺炎支原体聚合酶链式反应(PCR)检测的快速报告系统，使医生能够在下令进行测试约90分钟后获得测试结果。在这项研究中，我们评估了该制度自2016年5月至2017年4月实施后对儿科肺炎患者抗菌药物处方的影响。我们总共确定了375名儿童肺炎患者，90.7%(340/375)的患者立即报告了肺炎支原体的快速聚合酶链式反应检测结果，医生能够在开出抗菌药物之前根据这些结果来决定患者的治疗。在375例肺炎患儿中，检出肺炎支原体223例(59.5%)。在223例肺炎支原体阳性病例中，97.3%(217/223)的非典型病原体(大环内酯类、四环素类或喹诺酮类)的抗菌药物在最初评估时被开出，在管理过程中其处方率上升到99.1%(221/223)。相比之下，在最初的评估中，152例肺炎支原体阴性的肺炎患者中，只有10.5%的人开了针对非典型病原体的抗菌药，另外只有1例在治疗过程中因持续症状而开了克拉霉素。综上所述，我们认为分子技术可以应用于传染病的护理点检测领域，它的实施将确保儿童肺炎患者正确的抗菌药物处方。
Mycoplasma pneumoniae is a leading causative pathogen of pneumonia among pediatric patients, and its accurate diagnosis may aid in the selection of appropriate antimicrobial agents. We established a rapid reporting system of a polymerase chain reaction (PCR) examination for M. pneumoniae that enables physicians to obtain test results approximately 90 minutes after ordering the test. In this study, we evaluated the impact of this system on antimicrobial prescriptions for pediatric pneumonia patients after its implementation from May 2016 to April 2017. In total, we identified 375 pediatric pneumonia patients, and the results of the rapid PCR examinations for Mycoplasma pneumoniae were reported immediately in 90.7% of patients (340/375), with physicians able to use these results to decide on patients' management before the prescription of antimicrobial agents. Of the 375 pediatric pneumoniae patients, M. pneumoniae was detected in 223 (59.5%). Among the 223 M. pneumoniae-positive pneumonia cases, antimicrobial agents for atypical pathogens (macrolides, tetracyclines or quinolones) were prescribed in 97.3% (217/223) at the initial evaluation, and their prescription rates increased to 99.1% (221/223) during management. In contrast, antimicrobial agents for atypical pathogens were prescribed only in 10.5% of 152 M. pneumoniae-negative pneumonia cases at the initial evaluations, and only 1 additional case was prescribed clarithromycin for persistent symptoms during management. In conclusion, we show that molecular technology could be applicable in the field of point-of-care testing in infectious disease, and its implementation will ensure the correct antimicrobial prescription for pediatric pneumonia patients.