The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial

BACKGROUND: Appropriate use of antimicrobials is essential to improve outcomes in sepsis. The aim of this study was to determine whether the use of a rapid molecular blood test—SeptiFast (SF) reduces the antibiotic consumption through early de-escalation in patients with nosocomial sepsis compared w...

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Autores principales: Rodrigues, Cristhieni, Siciliano, Rinaldo Focaccia, Filho, Helio Caiaffa, Charbel, Cecília Eugenia, de Carvalho Sarahyba da Silva, Luciane, Baiardo Redaelli, Martina, de Paula Rosa Passetti, Ana Paula, Franco, Maria Renata Gomes, Rossi, Flávia, Zeigler, Rogerio, De Backer, Daniel, Franco, Rafael Alves, de Almeida, Juliano Pinheiro, Rizk, Stéphanie Itala, Fukushima, Julia Tizue, Landoni, Giovanni, Uip, David Everson, Hajjar, Ludhmila Abrahão, Strabelli, Tania Mara Varejão
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647273/
https://www.ncbi.nlm.nih.gov/pubmed/31367384
http://dx.doi.org/10.1186/s40560-019-0391-3
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author Rodrigues, Cristhieni
Siciliano, Rinaldo Focaccia
Filho, Helio Caiaffa
Charbel, Cecília Eugenia
de Carvalho Sarahyba da Silva, Luciane
Baiardo Redaelli, Martina
de Paula Rosa Passetti, Ana Paula
Franco, Maria Renata Gomes
Rossi, Flávia
Zeigler, Rogerio
De Backer, Daniel
Franco, Rafael Alves
de Almeida, Juliano Pinheiro
Rizk, Stéphanie Itala
Fukushima, Julia Tizue
Landoni, Giovanni
Uip, David Everson
Hajjar, Ludhmila Abrahão
Strabelli, Tania Mara Varejão
author_facet Rodrigues, Cristhieni
Siciliano, Rinaldo Focaccia
Filho, Helio Caiaffa
Charbel, Cecília Eugenia
de Carvalho Sarahyba da Silva, Luciane
Baiardo Redaelli, Martina
de Paula Rosa Passetti, Ana Paula
Franco, Maria Renata Gomes
Rossi, Flávia
Zeigler, Rogerio
De Backer, Daniel
Franco, Rafael Alves
de Almeida, Juliano Pinheiro
Rizk, Stéphanie Itala
Fukushima, Julia Tizue
Landoni, Giovanni
Uip, David Everson
Hajjar, Ludhmila Abrahão
Strabelli, Tania Mara Varejão
author_sort Rodrigues, Cristhieni
collection PubMed
description BACKGROUND: Appropriate use of antimicrobials is essential to improve outcomes in sepsis. The aim of this study was to determine whether the use of a rapid molecular blood test—SeptiFast (SF) reduces the antibiotic consumption through early de-escalation in patients with nosocomial sepsis compared with conventional blood cultures (BCs). METHODS: This was a prospective, randomized, superiority, controlled trial conducted at Sao Paulo Heart Institute in the period October 2012–May 2016. Adult patients admitted to the hospital for at least 48 h with a diagnosis of nosocomial sepsis underwent microorganism identification by both SF test and BCs. Patients randomized into the intervention group received antibiotic therapy adjustment according to the results of SF. Patients randomized into the control group received standard antibiotic adjustment according to the results of BCs. The primary endpoint was antimicrobial consumption during the first 14 days after randomization. RESULTS: A total of 200 patients were included (100 in each group). The intention to treat analysis found no significant differences in median antibiotic consumption. In the subgroup of patients with positive SF and blood cultures (19 and 25 respectively), we found a statistically significant reduction in the median antimicrobial consumption which was 1429 (1071–2000) days of therapy (DOT)/1000 patients-day in the intervention group and 1889 (1357–2563) DOT/1000 patients-day in the control group (p = 0.017), in the median time of antimicrobial de-escalation (8 versus 54 h—p < 0.001), in the duration of antimicrobial therapy (p = 0.039) and in anti-gram-positive antimicrobial costs (p = 0.002). Microorganism identification was possible in 24.5% of patients (45/184) by SF and 21.2% (39/184) by BC (p = 0.45). CONCLUSION: This randomized clinical trial showed that the use of a rapid molecular-based pathogen identification test does not reduce the median antibiotic consumption in nosocomial sepsis. However, in patients with positive microbiological tests, the use of SeptiFast reduced antimicrobial consumption through early de-escalation compared to conventional blood cultures. These results were driven by a reduction in the consumption of antimicrobials used for Gram-positive bacteria. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov (NCT 01450358) on 12th October 2011 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40560-019-0391-3) contains supplementary material, which is available to authorized users.
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spelling pubmed-66472732019-07-31 The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial Rodrigues, Cristhieni Siciliano, Rinaldo Focaccia Filho, Helio Caiaffa Charbel, Cecília Eugenia de Carvalho Sarahyba da Silva, Luciane Baiardo Redaelli, Martina de Paula Rosa Passetti, Ana Paula Franco, Maria Renata Gomes Rossi, Flávia Zeigler, Rogerio De Backer, Daniel Franco, Rafael Alves de Almeida, Juliano Pinheiro Rizk, Stéphanie Itala Fukushima, Julia Tizue Landoni, Giovanni Uip, David Everson Hajjar, Ludhmila Abrahão Strabelli, Tania Mara Varejão J Intensive Care Research BACKGROUND: Appropriate use of antimicrobials is essential to improve outcomes in sepsis. The aim of this study was to determine whether the use of a rapid molecular blood test—SeptiFast (SF) reduces the antibiotic consumption through early de-escalation in patients with nosocomial sepsis compared with conventional blood cultures (BCs). METHODS: This was a prospective, randomized, superiority, controlled trial conducted at Sao Paulo Heart Institute in the period October 2012–May 2016. Adult patients admitted to the hospital for at least 48 h with a diagnosis of nosocomial sepsis underwent microorganism identification by both SF test and BCs. Patients randomized into the intervention group received antibiotic therapy adjustment according to the results of SF. Patients randomized into the control group received standard antibiotic adjustment according to the results of BCs. The primary endpoint was antimicrobial consumption during the first 14 days after randomization. RESULTS: A total of 200 patients were included (100 in each group). The intention to treat analysis found no significant differences in median antibiotic consumption. In the subgroup of patients with positive SF and blood cultures (19 and 25 respectively), we found a statistically significant reduction in the median antimicrobial consumption which was 1429 (1071–2000) days of therapy (DOT)/1000 patients-day in the intervention group and 1889 (1357–2563) DOT/1000 patients-day in the control group (p = 0.017), in the median time of antimicrobial de-escalation (8 versus 54 h—p < 0.001), in the duration of antimicrobial therapy (p = 0.039) and in anti-gram-positive antimicrobial costs (p = 0.002). Microorganism identification was possible in 24.5% of patients (45/184) by SF and 21.2% (39/184) by BC (p = 0.45). CONCLUSION: This randomized clinical trial showed that the use of a rapid molecular-based pathogen identification test does not reduce the median antibiotic consumption in nosocomial sepsis. However, in patients with positive microbiological tests, the use of SeptiFast reduced antimicrobial consumption through early de-escalation compared to conventional blood cultures. These results were driven by a reduction in the consumption of antimicrobials used for Gram-positive bacteria. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov (NCT 01450358) on 12th October 2011 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40560-019-0391-3) contains supplementary material, which is available to authorized users. BioMed Central 2019-07-22 /pmc/articles/PMC6647273/ /pubmed/31367384 http://dx.doi.org/10.1186/s40560-019-0391-3 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Rodrigues, Cristhieni
Siciliano, Rinaldo Focaccia
Filho, Helio Caiaffa
Charbel, Cecília Eugenia
de Carvalho Sarahyba da Silva, Luciane
Baiardo Redaelli, Martina
de Paula Rosa Passetti, Ana Paula
Franco, Maria Renata Gomes
Rossi, Flávia
Zeigler, Rogerio
De Backer, Daniel
Franco, Rafael Alves
de Almeida, Juliano Pinheiro
Rizk, Stéphanie Itala
Fukushima, Julia Tizue
Landoni, Giovanni
Uip, David Everson
Hajjar, Ludhmila Abrahão
Strabelli, Tania Mara Varejão
The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial
title The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial
title_full The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial
title_fullStr The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial
title_full_unstemmed The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial
title_short The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial
title_sort effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647273/
https://www.ncbi.nlm.nih.gov/pubmed/31367384
http://dx.doi.org/10.1186/s40560-019-0391-3
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