Evaluation of a molecular point-of-care testing for viral and atypical pathogens on intravenous antibiotic duration in hospitalized adults with lower respiratory tract infection: a randomized clinical trial
Evaluation of a molecular point-of-care testing for viral and atypical pathogens on intravenous antibiotic duration in hospitalized adults with lower respiratory tract infection: a randomized clinical trial
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对住院成人下呼吸道感染患者静脉注射抗生素持续时间的病毒和非典型病原体分子点护理检测的评价：一项随机临床试验
DOI：
10.1016/j.cmi.2019.06.012
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发表时间：
2019-11-01
影响因子：
14.2
通讯作者：
Cao, B.
中科院分区：
文献类型：
--
作者：
Shengchen, D.;Gu, X.;Cao, B.
目的：主要目的是评估与常规实时 PCR 相比，在常规实时 PCR 基础上添加针对病毒和非典型病原体的分子即时检测 (POCT) 是否可以缩短下呼吸道感染 (LRTI) 住院患者静脉注射抗生素的持续时间。 方法：在这项单中心、开放标签、随机对照研究中，我们纳入了诊断为 LRTI 的住院成人。患者被随机分为干预组（针对 20 种病毒、非典型病原体和细菌的 POCT FilmArray Panel 加上常规实时 PCR）或对照组（针对 10 种病原体的常规实时 PCR）。主要结局是住院期间静脉注射抗生素的持续时间。次要结局包括住院时间、住院费用以及 72 小时内和 72 小时至 7 天内的降级。采用意向治疗分析。结果：2017年10月至2018年7月期间，我们入组了800名符合条件的患者（干预组398名，对照组402名）。干预组静脉注射抗生素的持续时间短于对照组（7.0 天（四分位距 (IQR) 5.0-9.0）与 8.0 天（IQR 6.0-11.0）；p）
Objectives: The primary objective was to evaluate whether a molecular point-of-care test (POCT) for viral and atypical pathogens added to routine real-time PCR could reduce duration of intravenous antibiotics in hospitalized patients with lower respiratory tract infection (LRTI) compared with routine real-time PCR.Methods: In this single-centre, open-label, randomized controlled study, we enrolled hospitalized adults diagnosed with LRTI. Patients were randomized to an intervention group (POCT FilmArray Panel for 20 viruses, atypical pathogens and bacteria plus routine real-time PCR) or a control group (routine real-time PCR for ten pathogens). The primary outcome was duration of intravenous antibiotics during hospitalization. The secondary outcomes included length of stay, cost of hospitalization and de-escalation within 72 hours and between 72 hours and 7 days. Intention-to-treat analysis was used.Results: Between October 2017 and July 2018, we enrolled 800 eligible patients (398 in the intervention group and 402 in the control group). Duration of intravenous antibiotics in the intervention group was shorter than in the control (7.0 days (interquartile range (IQR) 5.0-9.0) versus 8.0 days (IQR 6.0-11.0); p