The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial

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art_RODRIGUES_The_effect_of_a_rapid_molecular_blood_test_2019.PDF (779.62 KB)
Citações na Scopus
13
Tipo de produção
article
Data de publicação
2019
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
BMC
Autores
REDAELLI, Martina Baiardo
Citação
JOURNAL OF INTENSIVE CARE, v.7, article ID 37, 9p, 2019
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: Appropriate use of antimicrobials is essential to improve outcomes in sepsis. The aim of this study was to determine whether the use of a rapid molecular blood test-SeptiFast (SF) reduces the antibiotic consumption through early de-escalation in patients with nosocomial sepsis compared with conventional blood cultures (BCs). Methods: This was a prospective, randomized, superiority, controlled trial conducted at Sao Paulo Heart Institute in the period October 2012-May 2016. Adult patients admitted to the hospital for at least 48h with a diagnosis of nosocomial sepsis underwent microorganism identification by both SF test and BCs. Patients randomized into the intervention group received antibiotic therapy adjustment according to the results of SF. Patients randomized into the control group received standard antibiotic adjustment according to the results of BCs. The primary endpoint was antimicrobial consumption during the first 14days after randomization. Results: A total of 200 patients were included (100 in each group). The intention to treat analysis found no significant differences in median antibiotic consumption. In the subgroup of patients with positive SF and blood cultures (19 and 25 respectively), we found a statistically significant reduction in the median antimicrobial consumption which was 1429 (1071-2000) days of therapy (DOT)/1000 patients-day in the intervention group and 1889 (1357-2563) DOT/1000 patients-day in the control group (p=0.017), in the median time of antimicrobial de-escalation (8 versus 54h-p<0.001), in the duration of antimicrobial therapy (p=0.039) and in anti-gram-positive antimicrobial costs (p=0.002). Microorganism identification was possible in 24.5% of patients (45/184) by SF and 21.2% (39/184) by BC (p=0.45). Conclusion: This randomized clinical trial showed that the use of a rapid molecular-based pathogen identification test does not reduce the median antibiotic consumption in nosocomial sepsis. However, in patients with positive microbiological tests, the use of SeptiFast reduced antimicrobial consumption through early de-escalation compared to conventional blood cultures. These results were driven by a reduction in the consumption of antimicrobials used for Gram-positive bacteria.
Palavras-chave
Sepsis, Blood culture, Intensive care, Antibiotic therapy, Rapid molecular test, Nosocomial infection, Critical care, Randomized controlled trial
URI
https://observatorio.fm.usp.br/handle/OPI/33053
Referências
  1. Angus DC, 2001, CRIT CARE MED, V29, P1303, DOI 10.1097/00003246-200107000-00002
  2. Bacconi A, 2014, J CLIN MICROBIOL, V52, P3164, DOI 10.1128/JCM.00801-14
  3. Dark P, 2015, INTENS CARE MED, V41, P21, DOI 10.1007/s00134-014-3553-8
  4. Davey P, 2013, COCHRANE DB SYST REV, DOI [10.1002/14651858.CD003543.pub3, 10.1002/14651858.CD003543.pub4]
  5. Dellinger RP, 2013, CRIT CARE MED, V41, P580, DOI 10.1097/CCM.0b013e31827e83af
  6. Doron S, 2011, MAYO CLIN PROC, V86, P1113, DOI 10.4065/mcp.2011.0358
  7. GARNER JS, 1988, AM J INFECT CONTROL, V16, P128, DOI 10.1016/0196-6553(88)90053-3
  8. Geissler A, 2003, INTENS CARE MED, V29, P49, DOI 10.1007/s00134-002-1565-2
  9. Greco R, 2018, BONE MARROW TRANSPL, V53, P410, DOI 10.1038/s41409-017-0039-7
  10. Hall Margaret Jean, 2011, NCHS Data Brief, P1
  11. Havey TC, 2013, CAN J INFECT DIS MED, V24, P129, DOI 10.1155/2013/141989
  12. Hill JT, 2014, J CLIN MICROBIOL, V52, P3805, DOI 10.1128/JCM.01537-14
  13. Kaki R, 2011, J ANTIMICROB CHEMOTH, V66, P1223, DOI 10.1093/jac/dkr137
  14. KNAUS WA, 1985, CRIT CARE MED, V13, P818, DOI 10.1097/00003246-198510000-00009
  15. Larmann Jan, 2004, Best Pract Res Clin Anaesthesiol, V18, P425
  16. Lehmann LE, 2008, MED MICROBIOL IMMUN, V197, P313, DOI 10.1007/s00430-007-0063-0
  17. Liesenfeld O, 2014, EUR J MICROBIOL IMMU, V4, P1, DOI 10.1556/EuJMI.4.2014.1.1
  18. Molina Jose Miguel, 2008, Enferm Infecc Microbiol Clin, V26 Suppl 9, P75
  19. Ohji G, 2016, INT J INFECT DIS, V49, P71, DOI 10.1016/j.ijid.2016.06.002
  20. Pasqualini L, 2012, J CLIN MICROBIOL, V50, P1285, DOI 10.1128/JCM.06793-11
  21. Polk RE, 2007, CLIN INFECT DIS, V44, P664, DOI 10.1086/511640
  22. Previsdomini M, 2012, CROAT MED J, V53, P30, DOI 10.3325/cmj.2012.53.30
  23. Rimawi RH, 2013, CRIT CARE MED, V41, P2099, DOI 10.1097/CCM.0b013e31828e9863
  24. Scerbo MH, 2016, SURG INFECT, V17, P294, DOI 10.1089/sur.2015.099
  25. Singer M, 2016, JAMA-J AM MED ASSOC, V315, P801, DOI 10.1001/jama.2016.0287
  26. Skvarc M, 2013, EUR J MICROBIOL IMMU, V3, P97, DOI 10.1556/EuJMI.3.2013.2.2
  27. Vincent JL, 1996, INTENS CARE MED, V22, P707, DOI 10.1007/BF01709751
  28. World Health Organization, 2015, GLOB ACT PLAN ANT RE
  29. Yanagihara K, 2010, CRIT CARE, V14, DOI 10.1186/cc9234

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/03
Artigos e Materiais de Revistas Científicas - LIM/08
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