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Development of a Comprehensive Program for the Early Diagnosis and Treatment of Severe Infections in a Tertiary
Guillermo Martín-Gutiérrez1,2,3,4, José Molina1,2,3, Carlos Martín-Pérez
1Clinical Unit of Infectious Diseases, Microbiology and Parasitology, University Hospital Virgen del Rocío, Seville, Spain.
Background:
To assess the impact of the rapid diagnosis and treatment of severe infections (rDTSI) program on diagnostic and clinical outcomes in patients with severe infections.
Method:
We conducted a pre-post quasi-experimental study evaluating patients with severe pneumonia or sepsis before (October 2019-February 2020) and after (March 2022-March 2023) rDTSI implementation. The program integrated rapid molecular diagnostics, a 24/7 laboratory workflow, and multidisciplinary training. Primary outcomes included time from clinical diagnosis to pathogen-directed therapy and targeted therapy within 48 h. Secondary outcomes assessed antimicrobial appropriateness (DOOR-MAT), length of stay, and mortality.
Results:
The rDTSI program significantly reduced the median time to pathogen-directed therapy in pneumonia (48.8 vs 23.6 h, P < .001) and increased targeted therapy within 48 h (36.17% to 58.14%, P = .049). Hospital stays decreased (38.9 to 22.2 days, P < .001). In sepsis, diagnostic times (19.4 vs 18.1 h, P = .028) and DOOR-MAT scores (80.4 vs 88.0, P = .024) improved, while other clinical outcomes remained unchanged.
Conclusions:
The rDTSI program accelerated microbiological diagnosis, optimized antimicrobial therapy, and improved hospital efficiency in severe infections. These findings support integrating rapid diagnostics into antimicrobial stewardship programs to enhance severe infection management.
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