Clinical and Microbiological Impact of Implementing a Decision Support Algorithm through Microbiologic Rapid Diagnosis in Critically Ill Patients: An Epidemiological Retrospective Pre-Post-Intervention Study

Identificador:  imarina:9366645

Handle: https://hdl.handle.net/20.500.11797/imarina9366645

Autors:  Rodriguez, Alejandro; Gomez, Frederic; Sarvise, Carolina; Gutierrez, Cristina; Giralt, Montserrat Galofre; Guerrero-Torres, Maria Dolores; Pardo-Granell, Sergio; Pico-Plana, Ester; Benavent-Bofill, Clara; Trefler, Sandra; Berrueta, Julen; Canadell, Laura; Claverias, Laura; Esteve Pitarch, Erika; Olona, Montserrat; Garcia Pardo, Graciano; Teixido, Xavier; Bordonado, Laura; Sans, Maria Teresa; Bodi, Maria

Resum:
Background: Data on the benefits of rapid microbiological testing on antimicrobial consumption (AC) and antimicrobial resistance patterns (ARPs) are scarce. We evaluated the impact of a protocol based on rapid techniques on AC and ARP in intensive care (ICU) patients. Methods: A retrospective pre- (2018) and post-intervention (2019-2021) study was conducted in ICU patients. A rapid diagnostic algorithm was applied starting in 2019 in patients with a lower respiratory tract infection. The incidence of nosocomial infections, ARPs, and AC as DDDs (defined daily doses) were monitored. Results: A total of 3635 patients were included: 987 in the pre-intervention group and 2648 in the post-intervention group. The median age was 60 years, the sample was 64% male, and the average APACHE II and SOFA scores were 19 points and 3 points. The overall ICU mortality was 17.2% without any differences between the groups. An increase in the number of infections was observed in the post-intervention group (44.5% vs. 17.9%, p < 0.01), especially due to an increase in the incidence of ventilator-associated pneumonia (44.6% vs. 25%, p < 0.001). AC decreased from 128.7 DDD in 2018 to 66.0 DDD in 2021 (rate ratio = 0.51). An increase in Pseudomonas aeruginosa susceptibility of 23% for Piperacillin/tazobactam and 31% for Meropenem was observed. Conclusion: The implementation of an algorithm based on rapid microbiological diagnostic techniques allowed for a significant reduction in AC and ARPs without affecting the prognosis of critically ill patients.