PURPOSE This study examines the impacts of a skin and soft tissue infection (SSTI) management program involving a rapid diagnostic algorithm (Gram stain plus real-time PCR, GeneXpert® MRSA/SA SSTI) performed directly on clinical samples plus antimicrobial stewardship (AMS) counseling of the responsible physician. METHODS Participants were 155 consecutive adult inpatients with SSTI and good quality clinical samples submitted to the microbiology laboratory from April 2016 to January 2017. Results of the rapid test and AMS recommendations were phoned through to the responsible physician. The comparison group was a historical cohort. RESULTS Most SSTI were surgical wound infections (41.3% vs 38.1% for the intervention and comparison groups respectively) followed by diabetic foot (14.2% and 18.1%), abscesses (13.5% both) and cellulitis (12.9% both). Isolated microorganisms were mostly Gram-negative bacilli (two-thirds), followed by Staphylococcus aureus (SA). The ratio methicillin-susceptible SA (MSSA) to methicillin-resistant SA (MRSA) was 4:1. Improvements in the intervention cohort were: DOT (22.0 vs. 24.3 days, p = 0.007), treatment duration per SSTI episode (14.1 vs. 15.0 days, p = 0.072), treatment cost (433.1 vs. 533.3 €, p = 0.039), length of stay (18.6 vs 20.7 days, p = 0.031), related mortality (1 vs. 4 patients, p = 0.022) and Clostridium difficile infection (CDI) (4 vs. 8 patients, p = 0.050). In 48 cases (31.4%) in the intervention group, advice was given to improve empiric antibiotic treatment. CONCLUSION This type of program could help adjust antibiotic treatment when inappropriate, reducing antibiotic use and costs, length of stay, CDI and related mortality.

中文翻译：

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基于快速分子测试（GeneXpert®MRSA / SA SSTI）和抗菌管理的快速通道SSTI管理程序。

目的这项研究检查了皮肤和软组织感染（SSTI）管理程序的影响，该程序涉及对临床样品直接进行的快速诊断算法（革兰氏染色加实时PCR，GeneXpert®MRSA / SA SSTI）以及抗菌素管理（AMS）负责医师的咨询。方法参加者为2016年4月至2017年1月向微生物学实验室提交的155例SSTI和高质量临床样本的成人住院患者。快速检测结果和AMS建议通过电话告知负责的医生。比较组是一个历史队列。结果大多数SSTI为手术伤口感染（干预组和比较组分别为41.3％和38.1％），其次是糖尿病足（分别为14.2％和18.1％），脓肿（均13.5％）和蜂窝织炎（均12.9％）。分离出的微生物主要是革兰氏阴性杆菌（三分之二），其次是金黄色葡萄球菌（SA）。耐甲氧西林的SA（MSSA）与耐甲氧西林的SA（MRSA）之比为4：1。干预队列的改善包括：DOT（22.0 vs. 24.3天，p = 0.007），每个SSTI发作的治疗持续时间（14.1 vs. 15.0天，p = 0.072），治疗费用（433.1 vs. 533.3€，p = 0.039） ，住院天数（18.6 vs 20.7天，p = 0.031），相关死亡率（1 vs. 4例患者，p = 0.022）和艰难梭菌感染（CDI）（4 vs. 8例，p = 0.050）。干预组中有48例（31.4％）患者被建议改善经验性抗生素治疗。结论此类计划可在不适当的情况下帮助调整抗生素治疗，减少抗生素的使用和费用，住院时间，CDI和相关死亡率。