Articles producció científica> Medicina i Cirurgia

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

  • Identification data

    Identifier: imarina:9333904
    Authors:
    Rodriguez, AGomez, FSarvise, CGutierrez, CGiralt, MGGuerrero-Torres, MDPardo-Granell, SPico-Plana, EBenavent-Bofill, CTrefler, SBerrueta, JCanadell, LClaverias, LPitarch, EEOlona, MPardo, GGTeixido, XBordonado, LSans, MTBodi, MBlasi, FB
    Abstract:
    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.
  • Others:

    Author, as appears in the article.: Rodriguez, A; Gomez, F; Sarvise, C; Gutierrez, C; Giralt, MG; Guerrero-Torres, MD; Pardo-Granell, S; Pico-Plana, E; Benavent-Bofill, C; Trefler, S; Berrueta, J; Canadell, L; Claverias, L; Pitarch, EE; Olona, M; Pardo, GG; Teixido, X; Bordonado, L; Sans, MT; Bodi, M; Blasi, FB
    Department: Ciències Mèdiques Bàsiques Medicina i Cirurgia
    URV's Author/s: Bodi Saera, Maria Amparo / Canadell Vilarrasa, Laura / Garcia Pardo, Graciano / Gomez Bertomeu, Frederic-Francesc / Olona Cabases, Maria Montserrat / Rodríguez Oviedo, Alejandro Hugo / TREFLER CRESPO, SANDRA INES
    Keywords: Ventilator-associated pneumonia Rapid microbiological diagnostic techniques Nosocomial infection Infections Filmarrays Defined daily dose Antimicrobial consumption ventilator-associated pneumonia rapid microbiological diagnostic techniques filmarrays defined daily dose antimicrobial consumption
    Abstract: 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.
    Thematic Areas: Pharmacology & pharmacy Medicine, research & experimental Medicine (miscellaneous) General biochemistry,genetics and molecular biology Ciencias sociales Biochemistry, genetics and molecular biology (miscellaneous) Biochemistry, genetics and molecular biology (all) Biochemistry & molecular biology
    licence for use: https://creativecommons.org/licenses/by/3.0/es/
    Author's mail: graciano.garcia@urv.cat alejandrohugo.rodriguez@urv.cat mariamontserrat.olona@urv.cat laura.canadell@urv.cat frederic-francesc.gomez@urv.cat mariaamparo.bodi@urv.cat mariaamparo.bodi@urv.cat
    Author identifier: 0000-0001-8828-5984 0000-0002-8039-2889 0000-0001-7652-8379 0000-0001-7652-8379
    Record's date: 2024-03-12
    Papper version: info:eu-repo/semantics/publishedVersion
    Link to the original source: https://www.mdpi.com/2227-9059/11/12/3330
    Papper original source: Biomedicines. 11 (12):
    APA: Rodriguez, A; Gomez, F; Sarvise, C; Gutierrez, C; Giralt, MG; Guerrero-Torres, MD; Pardo-Granell, S; Pico-Plana, E; Benavent-Bofill, C; Trefler, S; Be (2023). 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. Biomedicines, 11(12), -. DOI: 10.3390/biomedicines11123330
    Licence document URL: https://repositori.urv.cat/ca/proteccio-de-dades/
    Article's DOI: 10.3390/biomedicines11123330
    Entity: Universitat Rovira i Virgili
    Journal publication year: 2023
    Publication Type: Journal Publications
  • Keywords:

    Biochemistry & Molecular Biology,Biochemistry, Genetics and Molecular Biology (Miscellaneous),Medicine (Miscellaneous),Medicine, Research & Experimental,Pharmacology & Pharmacy
    Ventilator-associated pneumonia
    Rapid microbiological diagnostic techniques
    Nosocomial infection
    Infections
    Filmarrays
    Defined daily dose
    Antimicrobial consumption
    ventilator-associated pneumonia
    rapid microbiological diagnostic techniques
    filmarrays
    defined daily dose
    antimicrobial consumption
    Pharmacology & pharmacy
    Medicine, research & experimental
    Medicine (miscellaneous)
    General biochemistry,genetics and molecular biology
    Ciencias sociales
    Biochemistry, genetics and molecular biology (miscellaneous)
    Biochemistry, genetics and molecular biology (all)
    Biochemistry & molecular biology
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