CLINICAL IMPACT OF RAPID IN-VITRO SUSCEPTIBILITY TESTING AND BACTERIAL IDENTIFICATION
CLINICAL IMPACT OF RAPID IN-VITRO SUSCEPTIBILITY TESTING AND BACTERIAL IDENTIFICATION
复制标题
DOI：
10.1128/jcm.32.7.1757-1762.1994
复制
发表时间：
1994-07-01
影响因子：
9.4
通讯作者：
LEVY, B
中科院分区：
文献类型：
--
作者：
DOERN, GV;VAUTOUR, R;LEVY, B
在过去的十年中，各种仪器辅助的细菌鉴定和抗菌药物敏感性测试系统已经开发出来，这些系统允许在几个小时而不是几天内提供测试结果，而传统的通宵程序就是这样。这些新的快速技术比旧的方法昂贵得多。据推测，对感染患者进行快速检测的临床益处抵消了增加的成本，但尚未得到证实。本研究的目的是客观地确定快速细菌鉴定和抗菌药物敏感性试验的临床影响。进行了一项为期一年的研究，其中将三级护理，教学，医疗中心的感染住院患者随机分配到两组之一：使用半自动，快速，当天程序进行鉴定和药敏试验的患者和使用传统过夜技术完成检测的患者。比较两组患者的许多人口统计学描述符，然后对患者进行前瞻性监测，直至住院结束，目的是确定两组之间是否存在客观可定义的管理和结局差异。快速检测组提供药敏和鉴别试验结果的平均时间长度分别为11.3和9.6 h。在过夜试验组中，这些值分别为19.6和25.9 h（P < 0.0005）。第一组有273例可评价患者，第二组有300例可评价患者。除了提供易感性和识别测试结果所需的时间长度之外，在> 100个人口统计描述符方面，两组之间没有显着差异。关于结果的测量，两组的平均住院时间也相同。然而，快速检测组的死亡率较低（即，8.8%对15.3%）。同样，快速检测组患者的实验室检查、影像学检查、插管天数和重症监护或中间监护区天数在统计学上显著缩短。快速检测还与抗菌治疗改变前所用时间的显著缩短相关。最后，快速检测组的患者住院费用显著较低。这项研究的结果表明，在微生物实验室进行快速的细菌鉴定和药敏试验，可以对住院感染患者的护理和结果产生重大影响。
During the past decade, a variety of instrument-assisted bacterial identification and antimicrobial susceptibility test systems have been developed which permit provision of test results in a matter of hours rather than days, as has been the case with traditional overnight procedures. These newer rapid techniques are much more expensive than older methods. It has been presumed but not proven that the clinical benefits of rapid testing to patients with infection offset the added cost. The intent of this study nas to objectively define the clinical impact of rapid bacterial identification and antimicrobial susceptibility testing. A I-year study was performed in which infected, hospitalized patients in a tertiary-care, teaching, medical center were randomly assigned to one of two groups: patients for whom identification and susceptibility testing was performed by using a semi-automated, rapid, same-day procedure and those for whom testing was accomplished by using traditional overnight techniques. The two groups were compared with respect to numerous demographic descriptors, and then patients were monitored prospectively through the end of their hospitalization with the aim of determining whether there existed objectively defineable differences in management and outcome; between the two groups. The mean lengths of time to provision of susceptibility and identification test results in the rapid test group were 11.3 and 9.6 h, respectively. In the overnight test group, these values were 19.6 and 25.9 h, respectively (P < 0.0005). There were 273 evaluable patients in the first group and 300 in the second group. Other than the length of time required to provide susceptibility and identification test results, no significant differences were noted between the two groups,vith respect to > 100 demographic descriptors. With regard to measures of outcome, the mean lengths of hospitalization were also the same in both groups. Mortality rates were, however, lower in the rapid test group (i.e., 8.8% versus 15.3%). Similarly, statistically significantly fe,ver laboratory studies, imaging procedures, days of intubation, and days in an intensive or intermediate-care area were observed with patients in the rapid test group. Rapid testing was also associated with significantly shortened lengths of elapsed time prior to alterations in antimicrobial therapy. Lastly, patient costs for hospitalization were significantly lower in the rapid test group. The results of this study indicate the rapid same-day bacterial identification and susceptibility testing in the microbiology laboratory can have a major impact on the care and outcome of hospitalized patients with infection.