Early adjustment of empirical antibiotic therapy of bloodstream infections on the basis of direct identification of bacteria by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and Gram staining results.
J Infect Chemother
; 26(9): 963-969, 2020 Sep.
Article
em En
| MEDLINE
| ID: mdl-32386929
ABSTRACT
INTRODUCTION:
To assess the potential added value of rapid MALDI-TOF MS-based identification of bacteria in positive blood cultures to the information provided by Gram staining for adequate empirical antibiotic treatment adjustments in patients with bloodstream infections (BSI).METHODS:
We conducted a retrospective, single-center, pre-post quasi-experimental study. In the pre-MALDI-TOF MS phase of the study antibiotic adjustments were made on the basis of Gram stain results, whereas in the MALDI-TOF MS phase they were based on information provided by Gram staining and MALDI-TOF MS results. No antimicrobial stewardship program for BSI was in place within the study period. Antibiotic regimens were categorized as correct, improvable or incorrect.RESULTS:
Cohorts were matched for demographics, clinical characteristics of patients and bacterial species involved. Enterobacteriales were the most represented in both study periods (67%), followed by Non-fermenting Gram-negative bacilli and Gram-positive cocci. The number of patients receiving correct, improvable and incorrect empirical antibiotic treatments was comparable for both study periods (P = 0.45, P = 0.57, P = 0.87, respectively). The percentage of patients who ended up receiving correct treatment following modified empirical antibiotic regimens was significantly higher (P = 0.008) in the MALDI-TOF MS phase (27 patients/38.6%) than in the pre-MALDI-TOF MS phase of the study (11 patients/15.7%), although overall adequate coverage of the bacteria causing the infection was comparable across the study periods (90%).CONCLUSION:
Gram stain results offer valuable information for early adjustment of empirical antibiotic therapies for BSI. Nevertheless, rapid identification of bacteria involved in BSI by MALDI-TOF MS provides added value to achieve this aim.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Bacteriemia
/
Sepse
Tipo de estudo:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article