RESUMO
We sought to evaluate time for bacterial culture and initiation of appropriate therapy for patients, from 2017 (without rapid diagnostic test (RDT) and Antimicrobial Stewardship Program (ASP)) and 2018 (with RDT and ASP). Time to identification (ID) was significantly faster in 2018 (2018 24.9⯱â¯14.4, 2017 33.8⯱â¯17â¯h, Pâ¯=â¯0.001). Time to antimicrobial susceptibility test (AST) results was significantly faster for patients in 2018 compared to 2017 (18.2⯱â¯14â¯h compared to 28.5⯱â¯14.9â¯h, Pâ¯<â¯0.001). Length of hospital stay for enrolled patients was significantly shorter in 2018 compared to 2017 (2018 10.7⯱â¯11.1â¯days and 2017 15.5⯱â¯18.1â¯days, Pâ¯=â¯0.05). Length of antimicrobial therapy for enrolled patients was significantly shorter for 2018 (2018 6.7⯱â¯3.8 d vs. 2017 8.8⯱â¯7.8 d, Pâ¯=â¯0.036). These results demonstrate MALDI-TOF/Vitek 2 leads to an average 21.5â¯h faster ID and AST results that can be acted upon by ASP for antimicrobial recommendations.
Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Infecções/diagnóstico , Infecções/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Feminino , Hospitalização , Humanos , Infecções/microbiologia , Tempo de Internação , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Fatores de Tempo , Resultado do TratamentoRESUMO
A 79-year-old Caucasian man presented with multiple leg abscesses due to Nocardia pseudobrasiliensis. He was on chronic steroid therapy for myasthenia gravis. We present the difficulties in diagnosis and treatment of this rare organism. N. pseudobrasiliensis is a new emerging species that was previously thought to belong to the N. brasiliensis species. The distinction between the two species is extremely important given the different antibiotic susceptibility pattern and association of N. pseudobrasiliensis with more invasive and disseminated disease.