Objectives

Recently, rapid phenotypic antimicrobial susceptibility testing (AST) based on microscopic imaging analysis has been developed. The aim of this study was to determine whether implementation of antimicrobial stewardship programmes (ASP) based on rapid phenotypic AST can increase the proportion of patients with haematological malignancies who receive optimal targeted antibiotics during early periods of bacteraemia.

Methods

This randomized controlled trial enrolled patients with haematological malignancies and at least one positive blood culture. Patients were randomly assigned 1:1 to conventional (n = 60) or rapid phenotypic (n = 56) AST. The primary outcome was the proportion of patients receiving optimal targeted antibiotics 72 hr after blood collection for culture.

Results

The percentage receiving optimal targeted antibiotics at 72 hr was significantly higher in the rapid phenotypic AST group (45/56, 80.4%) than in conventional AST group (34/60, 56.7%) (relative risk (RR) 1.42, 95% confidence interval (CI) 1.09–1.83). The percentage receiving unnecessary broad-spectrum antibiotics at 72 hr was significantly lower (7/26, 12.5% vs 18/60, 30.0%; RR 0.42, 95% CI 0.19–0.92) and the mean time to optimal targeted antibiotic treatment was significantly shorter (38.1, standard deviation (SD) 38.2 vs 72.8, SD 93.0 hr; p < 0.001) in the rapid phenotypic AST group. The mean time from blood collection to the AST result was significantly shorter in the rapid phenotypic AST group (48.3, SD 17.6 vs 83.1, SD 22.2 hr).

Discussion

ASP based on rapid phenotypic AST can rapidly optimize antibiotic treatment for bacteraemia in patients with haematological malignancy. Rapid phenotypic AST can improve antimicrobial stewardship in immunocompromised patients.

中文翻译：

---

基于对血液系统恶性肿瘤患者菌血症的快速表型抗菌药物敏感性测试加强抗菌药物管理：一项随机对照试验。

目标

最近，已经开发了基于显微成像分析的快速表型抗菌药敏试验 (AST)。本研究的目的是确定基于快速表型 AST 的抗菌药物管理计划 (ASP) 的实施是否可以增加血液系统恶性肿瘤患者在菌血症早期接受最佳靶向抗生素的比例。

方法

这项随机对照试验招募了患有血液系统恶性肿瘤且至少一种血培养阳性的患者。患者按 1:1 随机分配到常规 ( n  = 60) 或快速表型 ( n  = 56) AST。主要结果是在采血培养后 72 小时接受最佳靶向抗生素的患者比例。

结果

快速表型 AST 组（45/56，80.4%）在 72 小时时接受最佳靶向抗生素治疗的百分比显着高于常规 AST 组（34/60，56.7%）（相对风险（RR）1.42，95% 置信度）间隔 (CI) 1.09–1.83）。在 72 小时内接受不必要的广谱抗生素治疗的百分比显着降低（7/26，12.5% 与 18/60，30.0%；RR 0.42，95% CI 0.19–0.92）并且达到最佳靶向抗生素治疗的平均时间显着降低在快速表型 AST 组中更短（38.1，标准偏差 (SD) 38.2 vs 72.8，SD 93.0 小时；p < 0.001）。快速表型 AST 组从采血到 AST 结果的平均时间显着缩短（48.3，SD 17.6 vs 83.1，SD 22.2 小时）。

讨论

基于快速表型 AST 的 ASP 可以快速优化对血液系统恶性肿瘤患者菌血症的抗生素治疗。快速表型 AST 可以改善免疫功能低下患者的抗菌药物管理。