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

Rodríguez, A.; Gómez, F.; Sarvisé, C.; Gutiérrez, C.; Giralt, M.G.; Guerrero-Torres, M.D.; Pardo-Granell, S.; Picó-Plana, E.; Benavent-Bofill, C.; Trefler, S.; Berrueta, J.; Canadell, L.; Claverias, L.; Esteve Pitarch, E.; Olona, M.; García Pardo, G.; Teixidó, X.; Bordonado, L.; Sans, M.T.; Bodí, M. 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 2023, 11, 3330. Rodríguez, A.; Gómez, F.; Sarvisé, C.; Gutiérrez, C.; Giralt, M.G.; Guerrero-Torres, M.D.; Pardo-Granell, S.; Picó-Plana, E.; Benavent-Bofill, C.; Trefler, S.; Berrueta, J.; Canadell, L.; Claverias, L.; Esteve Pitarch, E.; Olona, M.; García Pardo, G.; Teixidó, X.; Bordonado, L.; Sans, M.T.; Bodí, M. 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 2023, 11, 3330.

Abstract

Background: Data on the benefits of rapid microbiological testing on antimicrobial consumption (AC) and antimicrobial resistance patterns(ARP) are scarce. We evaluated the impact of a protocol based on rapid techniques on AC and ARP in intensive care (ICU) patients. Methods: Retrospective pre(2018) and post-intervention(2019-21) study in ICU patients. A rapid diagnostic algorithm was applied from 2019 in patients with lower respiratory tract infection. Incidence of nosocomial infection, ARP, and AC as DDD(defined daily dose) were monitored. Results: A total of 3635 patients were included, 987(pre-intervention) and 2648(post-intervention). A median age was 60 years, 64% male, with APACHE II of 19 points and SOFA of 3 points. Overall ICU mortality of 17.2% without differences between the periods. An increase in the number of infections was observed in the post-intervention period(44.5% vs 17.9%, p<0.01), especially due to an increase in 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). A recovery of P.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 a significant reduction in AC and ARP without affecting the prognosis of critically ill patients.

Keywords

hospital infection; rapid microbiological test; antimicrobial consumption; defined daily dose; ventilator-associated pneumonia; filmarrays

Subject

Medicine and Pharmacology, Pulmonary and Respiratory Medicine

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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