直接磁盘扩散测试在指导抗生素治疗格兰阴性细菌病的临床实用性
Edwin Kwan-Yeung Chiu1, Ting-Fung Ma2, King-Pui Florence Chan3
1Department of Microbiology, The University of Hong Kong, Hong Kong SAR, China.
概括
直接磁盘扩散测试 (dDDT) 显著加快了格拉姆阴性细菌病的抗生素敏感性结果. 这种快速测试改善了适当的抗生素使用,并支持了抗生素管理,尽管它不是生存的独立预测指标.
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
- 抗微生物药物管理管理
背景情况:
- 传统的抗生素敏感性测试 (AST) 血流感染通常需要超过48小时,延迟最佳患者治疗.
- 快速的AST对于控制格拉姆阴性细菌症至关重要,特别是随着抗菌素耐药性增加.
研究的目的:
- 评估实施直接磁盘扩散测试 (dDDT) 对格拉姆阴性细菌病的临床影响.
- 评估结果的时间变化,治疗适当性和dDDT实施后的患者死亡率.
主要方法:
- 一个回顾性队列研究,比较在dDDT实施之前和之后患有格拉姆阴性细菌病的患者.
- 分析包括30天死亡率 (卡普兰-梅尔,考克斯回归),治疗适当性和抗生素谱指数 (ASI).
主要成果:
- dDDT将敏感性结果的平均时间减少了24小时.
- 对多药耐药生物体的治疗适宜性显著改善 (76.5%至91.2%,P=0.048).
- 在dDDT后观察到较低累积死亡率的趋势 (P=0.023),但dDDT不是30天死亡率的独立预测因素.
结论:
- dDDT的实施显著缩短了Gram阴性细菌病的结果的时间.
- 它提高了抗生素的适当性,有助于及时管理抗生素.
- 虽然显示出降低死亡率的趋势,但dDDT对生存的影响是多因素的.
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