多重聚合酶链反应试验对脑膜炎或脑炎患者的影响
Daisuke Kitagawa1,2, Taito Kitano3, Yuto Uchihara4
1Department of Laboratory Medicine, Nara Prefecture General Medical Center, Nara, Japan.
Open forum infectious diseases
|December 29, 2023
概括
电影Array脑膜炎/脑炎 (FAME) 专家小组显著减少了日本医院的抗病毒治疗时间. 然而,停留时间和抗菌剂的使用时间保持不变,需要进一步评估FAME.
科学领域:
- 临床微生物学 临床微生物学
- 传染性疾病 传染性疾病
- 医院流行病学 医院流行病学
背景情况:
- 电影Array脑膜炎/脑炎 (FAME) 面板是一种用于诊断中枢神经系统感染的多重核酸测试.
- 评估像FAME这样的诊断面板的临床和经济影响对于优化医院的患者护理和资源配置至关重要.
研究的目的:
- 评估实施FAME小组对儿科和成人患者抗菌药物治疗的停留时间 (LOS) 和持续时间的影响.
- 分析FAME小组采用后的诊断实践和病原体识别率的变化.
主要方法:
- 一项回顾性队列研究于2016年1月至2022年12月在日本社区医院进行.
- 包括患有脑脊液 (CSF) 样本的患者,具体标准为婴儿 (<2个月) 和白细胞计数升高 (≥5/μL) 的患者.
- 多变量波桑回归分析用于比较FAME前和FAME实施期间的治疗日 (DOT) 和LOS.
主要成果:
- 在FAME实施后,病原体特异性聚合酶链反应 (PCR) 的使用从3.7%显著增加到57.5% (P < .001).
- 病原体的整体鉴定率从0.4%上升到18.7% (P < .001).
- 虽然抗菌DOT没有显著差异 (aRR,1.06;P = .063),但抗病毒DOT在FAME期间显著减少 (aRR,0.80;P < .001).
结论:
- FAME小组导致抗病毒治疗持续时间显著减少,但没有影响LOS或抗菌剂的使用.
- 外部因素,如COVID-19流行病,可能影响了脑膜炎和脑炎的流行病学,混了观察到的结果.
- 建议对FAME的临床影响和脑膜炎/脑炎的流行病学进行持续监测,以完善其适当的使用.
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