细菌病患者的诊断不确定性:对抗生素处方和结果的影响
Pierre-Marie Roger1,2, Anne-Claire Strzelecki3, Véronique Dautezac4
1Infectiologie, Clinique Les Fleurs, 332, Ave. Frédéric Mistral, 83190 Ollioules, France.
The Journal of antimicrobial chemotherapy
|November 7, 2024
概括
诊断不确定性 (DU) 在阳性血液培养 (PBC) 患者中很常见,通常导致广泛的抗生素使用和较差的患者结果. 解决 DU 问题对于改善传染病管理至关重要.
科学领域:
- 传染性疾病 传染性疾病
- 临床微生物学 临床微生物学
- 医院流行病学 医院流行病学
背景情况:
- 在传染病中确立明确的诊断存在重大挑战.
- 阳性血液培养 (PBC) 表明潜在的严重感染,但并不总是明确特定的病因因因子或临床情况.
研究的目的:
- 描述PBC患者的诊断不确定性 (DU).
- 评估 DU 对抗生素治疗和患者治疗结果的影响.
主要方法:
- 六个月的前性多中心研究.
- 将PBC结果实时传达给传染病 (ID) 专家,以便 24/7 进行分析.
- DU定义为没有ID诊断或在图表审查和专家咨询后>2个差异诊断.
主要成果:
- 在199例PBC病例中,47%涉及诊断不确定性.
- DU与医疗病房住院 (aOR 6.94),开始抗生素治疗 (aOR 3.89),以及使用皮佩拉西林-塔扎巴克坦 (aOR 3.75) 相关.
- 低耗与不良结果有显著的联系 (aOR 5.07).
结论:
- 诊断的不确定性是常见的在阳性血液培养的患者.
- DU影响了抗生素处方模式,有利于更广泛的药物.
- 增加的诊断不确定性与较高的不良患者结局率相关.
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