RESUMO
BACKGROUND: We evaluated pre- and postimplementation of Virtuo on outcome in patients with gram-negative bacteremia using a quasiexperimental time-in-motion design. METHODS: Becton Dickinson BACTEC™ 9000 series (Bactec) (2018) and Virtuo system (2020) were utilized in a decentralized and centralized process, respectively. Data collected in August-December in 2018 and 2020 were analyzed with SPSS (ver 28). RESULTS: For 185 patients in each time period, patient age, gender, length of hospitalization were not different. However, blood culture (BC) volume was significantly lower in 2020 (7.1 ± 2.6 mL) compared to 2018 (8.9 ± 1.9 mL). Time from BC draw and time from pathogen identification (ID) to treatment change were both significantly faster in 2020 (52.9 ± 38.3 hours; 15.1 ± 27.4 hours), compared to 2018 (65.0 ± 46.3 hours; 23.8 ± 33.8), respectively. CONCLUSIONS: Replacement of decentralized Bactec with centralized Virtuo, resulted in significant improvement in management of patients gram-negative bacteremia.
Assuntos
Bacteriemia , Hemocultura , Humanos , Hemocultura/métodos , Fatores de Tempo , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Meios de Cultura , Técnicas Bacteriológicas/métodosRESUMO
We sought to evaluate time for bacterial culture and initiation of appropriate therapy for patients, from 2017 (without rapid diagnostic test (RDT) and Antimicrobial Stewardship Program (ASP)) and 2018 (with RDT and ASP). Time to identification (ID) was significantly faster in 2018 (2018 24.9⯱â¯14.4, 2017 33.8⯱â¯17â¯h, Pâ¯=â¯0.001). Time to antimicrobial susceptibility test (AST) results was significantly faster for patients in 2018 compared to 2017 (18.2⯱â¯14â¯h compared to 28.5⯱â¯14.9â¯h, Pâ¯<â¯0.001). Length of hospital stay for enrolled patients was significantly shorter in 2018 compared to 2017 (2018 10.7⯱â¯11.1â¯days and 2017 15.5⯱â¯18.1â¯days, Pâ¯=â¯0.05). Length of antimicrobial therapy for enrolled patients was significantly shorter for 2018 (2018 6.7⯱â¯3.8 d vs. 2017 8.8⯱â¯7.8 d, Pâ¯=â¯0.036). These results demonstrate MALDI-TOF/Vitek 2 leads to an average 21.5â¯h faster ID and AST results that can be acted upon by ASP for antimicrobial recommendations.
Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Infecções/diagnóstico , Infecções/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Feminino , Hospitalização , Humanos , Infecções/microbiologia , Tempo de Internação , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Fatores de Tempo , Resultado do TratamentoRESUMO
Three ertapenem-resistant Klebsiella pneumoniae carrying bla(KPC-2) were isolated from a single patient in Nebraska over a span of 5 months. A comparative analysis of the genetic relatedness of these isolates was investigated using pulsed-field gel electrophoresis, multilocus sequence typing, and whole genome mapping.
Assuntos
Mapeamento Cromossômico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/genética , beta-Lactamases/metabolismo , Antibacterianos/farmacologia , Eletroforese em Gel de Campo Pulsado , Genótipo , Humanos , Klebsiella pneumoniae/classificação , Klebsiella pneumoniae/isolamento & purificação , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Nebraska , beta-Lactamases/genéticaAssuntos
Infecções por Fusobacterium/diagnóstico , Fusobacterium necrophorum/isolamento & purificação , Infecções por Bactérias Gram-Positivas/diagnóstico , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/microbiologia , Peptostreptococcus/isolamento & purificação , Infecções Estreptocócicas/diagnóstico , Streptococcus/isolamento & purificação , Adolescente , Feminino , Infecções por Fusobacterium/fisiopatologia , Infecções por Bactérias Gram-Positivas/fisiopatologia , Humanos , Infecções Estreptocócicas/fisiopatologiaRESUMO
The new MONOLISA Bio-Rad kits were compared to DiaSorin kits for the detection of hepatitis B virus (HBV) total core (HBcTAb) and surface (HBsAb) antibodies on the Bio-Rad Evolis immunoanalyzer. The resolved sensitivities, specificities, positive and negative predictive values, and overall accuracy were 91%, 100%, 100%, 96%, and 97%, respectively, for HBcTAb and 99%, 95%, 96%, 99%, and 97%, respectively, for HBsAb. Whereas accuracy and reagent cost were comparable between the kits, Bio-Rad kits required less specimen volume and less instrument processing time to results than the DiaSorin kits.
Assuntos
Anticorpos Anti-Hepatite B/sangue , Antígenos do Núcleo do Vírus da Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/imunologia , Vírus da Hepatite B/imunologia , Hepatite B/imunologia , Kit de Reagentes para Diagnóstico , Reações Falso-Positivas , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Fatores de TempoRESUMO
beta-Lactamases produced by urine isolates from patients in long-term care facilities (LTCFs), outpatient, clinics, and one hospital in a U.S. community were characterized. A total of 1.3% of all Escherichia coli and Klebsiella pneumoniae isolates collected from patients in 30 LTCFs and various outpatient clinics produced extended-spectrum beta-lactamases (ESBLs) and/or imported AmpC beta-lactamases.
