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Clinical impact of matrix-assisted laser desorption ionization-time of flight mass spectrometry combined with antimicrobial stewardship interventions in patients with bloodstream infections in a Japanese tertiary hospital.
International Journal of Clinical Practice 2019 Februrary 28
BACKGROUND: Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has the potential to permit early organism identification and optimization of antibiotic therapy. However, MALDI-TOF MS combined with antimicrobial stewardship is available at only a limited number of institutions. Here, we evaluated the clinical impact of implementing MALDI-TOF MS combined with antimicrobial stewardship intervention in patients with bloodstream infections.
METHODS: We conducted a single-center, prospective cohort study to evaluate the clinical impact of implementing MALDI-TOF MS combined with antimicrobial stewardship intervention in patients with bloodstream infections. Processes and clinical outcomes in patients with bloodstream infections were compared before and after implementation of MALDI-TOF MS.
RESULTS: Compared to the conventional identification method, MALDI-TOF MS combined with antimicrobial stewardship intervention significantly decreased the time to organism identification (48.6±46.0 hours vs. 78.1±38.9 hours, P<0.001), effective antimicrobial therapy (13.0±19.0 hours vs. 26.2±44.8 hours, P<0.001) and optimal antimicrobial therapy (53.3±55.0 hours vs. 91.7 ± 88.7 hours, P<0.001. Moreover, the rate of clinical failure (14.0% vs. 33.3%, P<0.001) and incidence of adverse events (14.0% vs. 23.9%, P<0.001) was lower in the MALDI-TOF MS group than in the conventional identification group. A multivariate Cox proportional hazard analysis indicated that implementation of MALDI-TOF MS was a protective factor against clinical failure in patients with bloodstream infections (hazard ratio, 0.61; 95% confidence interval, 0.38-0.99; P=0.047).
CONCLUSIONS: Implementation of the MALDI-TOF MS combined with antimicrobial stewardship intervention facilitated early optimization of antimicrobial therapy with a remarkable concomitant reduction in clinical failure and adverse events in patients with bloodstream infections. This article is protected by copyright. All rights reserved.
METHODS: We conducted a single-center, prospective cohort study to evaluate the clinical impact of implementing MALDI-TOF MS combined with antimicrobial stewardship intervention in patients with bloodstream infections. Processes and clinical outcomes in patients with bloodstream infections were compared before and after implementation of MALDI-TOF MS.
RESULTS: Compared to the conventional identification method, MALDI-TOF MS combined with antimicrobial stewardship intervention significantly decreased the time to organism identification (48.6±46.0 hours vs. 78.1±38.9 hours, P<0.001), effective antimicrobial therapy (13.0±19.0 hours vs. 26.2±44.8 hours, P<0.001) and optimal antimicrobial therapy (53.3±55.0 hours vs. 91.7 ± 88.7 hours, P<0.001. Moreover, the rate of clinical failure (14.0% vs. 33.3%, P<0.001) and incidence of adverse events (14.0% vs. 23.9%, P<0.001) was lower in the MALDI-TOF MS group than in the conventional identification group. A multivariate Cox proportional hazard analysis indicated that implementation of MALDI-TOF MS was a protective factor against clinical failure in patients with bloodstream infections (hazard ratio, 0.61; 95% confidence interval, 0.38-0.99; P=0.047).
CONCLUSIONS: Implementation of the MALDI-TOF MS combined with antimicrobial stewardship intervention facilitated early optimization of antimicrobial therapy with a remarkable concomitant reduction in clinical failure and adverse events in patients with bloodstream infections. This article is protected by copyright. All rights reserved.
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