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Master Thesis

Impact de l’ouverture H24 du laboratoire du C.H.U. de Nice sur la prise en charge des bactériémies

Abstract : Background: Rapid microbial identification is pivotal in order to adapt antibiotic treatment and ensure its efficacy in bloodstream infections. We aimed to evaluate the clinical impact of an uninterrupted around the clock processing of blood cultures on antibiotic prescription and patient outcome.
Methods: Monomicrobial episodes of bacteremia were retrospectively evaluated over two four-month periods (pre and post-intervention), before and after a continuous 24/7 workflow system was implemented in our clinical microbiology laboratory. Species identification was performed by mass spectrometry directly on positive blood cultures. Primary outcome was the time from specimen collection to the first change in antibiotic therapy (CAT), defined as initiation, discontinuation, addition or switch occurring after detection of bacterial growth. Secondary outcomes were the time from specimen collection to efficient antibiotic therapy (defined as at least one molecule with in vitro activity on the causative pathogen), the time from collection to bacterial growth detection, to pathogen identification, and to antibiotic susceptibility testing results. Hospital length of stay and all-cause mortality at 30 days following bloodstream infection onset were also evaluated.
Results: 548 episodes of bacteremia in 515 patients were included in the final analysis. Mean time to CAT was reduced by 10.4 hours in the post-intervention group (POSTI, p<0.001). Mean time until efficient antibiotic therapy was reduced by 4.8h in POSTI (p<0.001) when empirical treatment was lacking or ineffective. The time from specimen collection to bacterial growth detection was reduced by 3.4h (p<0.001), the time to pathogen identification by 6.9h (p<0.001), and the time to susceptibility testing results by 5.1h (p=0.006) in POSTI. There was no difference in hospital length of stay between the two groups. At 30 days, 30 patients had died in PREI vs 23 in POSTI (p=0.5).
Conclusion: Around the clock processing of blood cultures allows for a faster change in antibiotic therapy and hastens the time to efficient antibiotic therapy prescription.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02326534
Contributor : Bibliothèque Universitaire de Médecine Nice <>
Submitted on : Tuesday, October 22, 2019 - 3:10:55 PM
Last modification on : Wednesday, October 14, 2020 - 4:23:21 AM

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2018NICEM119.pdf
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  • HAL Id : dumas-02326534, version 1

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David Chirio. Impact de l’ouverture H24 du laboratoire du C.H.U. de Nice sur la prise en charge des bactériémies. Médecine humaine et pathologie. 2018. ⟨dumas-02326534⟩

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