A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department.
A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department.
复制标题
多重胃肠道PCR面板的随机对照试验与通常的测试，以评估急诊科感染性腹泻患者的抗生素使用。
DOI：
10.1002/emp2.12616
复制
发表时间：
2022-03
影响因子：
2.3
通讯作者：
Ma Y
中科院分区：
文献类型：
--
作者：
Meltzer AC;Newton S;Lange J;Hall NC;Vargas NM;Huang Y;Moran S;Ma Y
这项研究通过对疑似急性感染性腹泻的急诊科(ED)患者使用多重胃肠道聚合酶链式反应(GI-PCR)测试和常规测试来分析医生的治疗行为，以评估抗生素管理的差异。设计了一项前瞻性、单中心、随机对照试验，以调查中重度疑似感染性腹泻的ED患者的抗生素使用情况，并将接受GI PCR的患者与接受常规检测的患者进行比较。有脱水、炎症或持续症状的ED患者被随机分为试验组(GI-PCR)或对照组(常规测试或不测试)。共有74名符合研究标准的患者被随机分为实验GI-PCR组(n=38)和对照组(n=36)。GI-PCR组87%的细菌性或原虫性腹泻感染(13/15)接受了抗生素治疗，而对照组46%(6/13)的患者接受了抗生素治疗(P值0.042)，2比差为0.41(95%可信区间为0.07和0.68)。与常规检测相比，多重GI聚合酶链式反应的使用导致细菌和原虫引起感染性腹泻的抗生素使用量增加。考虑到患者的中度到重度症状，以及对引起症状的可能细菌或原虫原因的明确识别，抗生素的增加似乎是适当的。由于样本量较小，对结果的解释应谨慎。
This study analyzed physician treating behavior through the use of a multiplex gastrointestinal polymerase chain reaction (GI PCR) test compared with usual testing in emergency department (ED) patients with suspected acute infectious diarrhea to assess differences in antibiotic management. A prospective, single‐center, randomized control trial was designed to investigate antibiotic use in ED patients with moderate to severe suspected infectious diarrhea, comparing those who received GI PCR to those who received usual testing. ED patients with signs of dehydration, inflammation, or persistent symptoms were randomized to either the experimental arm (GI PCR) or the control arm (usual testing or no testing). A total of 74 patients met study criteria and were randomized to either the experimental GI PCR arm (n = 38) or to the control arm (n = 36). Participants in the GI PCR arm received antibiotics in 87% of bacterial or protozoal diarrheal infections (13/15) whereas those in the control arm received antibiotics in 46% of bacterial or protozoal infections (6/13) (P value 0.042) with 2‐proportion difference 0.41 (95% confidence interval 0.07 and 0.68). ED use of multiplex GI PCR led to an increase in antibiotic use for bacterial and protozoal causes of infectious diarrhea compared to usual testing. This increase in antibiotics appears to be appropriate given patients’ moderate to severe symptoms and a definitive identification of a likely bacterial or protozoal cause of symptoms. Results should be interpreted with caution because of the small sample size.
登录
查看更多内容
DOI：
10.1016/s0140-6736(21)00425-6
发表时间：
2021-04-17
期刊：
Lancet (London, England)
影响因子：
--
作者：
Mina MJ;Peto TE;García-Fiñana M;Semple MG;Buchan IE
通讯作者：
Buchan IE
影响因子：
11.8
作者：
Shane, Andi L.;Mody, Rajal K.;Pickering, Larry K.
通讯作者：
Pickering, Larry K.
影响因子：
3.7
作者：
Machiels, Julian D.;Cremers, Amelieke J. H.;Melchers, Willem J. G.
通讯作者：
Melchers, Willem J. G.
影响因子：
11.8
作者：
Scallan E;Hoekstra RM;Angulo FJ;Tauxe RV;Widdowson MA;Roy SL;Jones JL;Griffin PM
通讯作者：
Griffin PM
影响因子：
1.5
作者：
Chan, SSW;Ng, KC;Rainer, TH
通讯作者：
Rainer, TH