Evaluation of a molecular point-of-care testing for viral and atypical pathogens on intravenous antibiotic duration in hospitalized adults with lower respiratory tract infection: a randomized clinical trial
单位：[1]Xuanwu Hospital of Capital Medical University, Beijing, China首都医科大学宣武医院[2]Department of Pulmonary and Critical Care Medicine, ChinaeJapan Friendship Hospital, Beijing, China[3]Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China首都医科大学附属安贞医院[4]Department of Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China[5]Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China[6]National Clinical Research Centre of Respiratory Diseases, Beijing, China[7]Department of Pulmonary and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China[8]Laboratory of Clinical Microbiology and Infectious Diseases, China-Japan Friendship Hospital, Beijing, China[9]Clinical Centre for Pulmonary Infections, Capital Medical University, Beijing, China[10]Tsinghua UniversityePeking University Joint Centre for Life Sciences, Beijing, China
Objectives: The primary objective was to evaluate whether a molecular point-of-care test (POCT) for viral and atypical pathogens added to routine real-time PCR could reduce duration of intravenous antibiotics in hospitalized patients with lower respiratory tract infection (LRTI) compared with routine real-time PCR. Methods: In this single-centre, open-label, randomized controlled study, we enrolled hospitalized adults diagnosed with LRTI. Patients were randomized to an intervention group (POCT FilmArray Panel for 20 viruses, atypical pathogens and bacteria plus routine real-time PCR) or a control group (routine real-time PCR for ten pathogens). The primary outcome was duration of intravenous antibiotics during hospitalization. The secondary outcomes included length of stay, cost of hospitalization and de-escalation within 72 hours and between 72 hours and 7 days. Intention-to-treat analysis was used. Results: Between October 2017 and July 2018, we enrolled 800 eligible patients (398 in the intervention group and 402 in the control group). Duration of intravenous antibiotics in the intervention group was shorter than in the control (7.0 days (interquartile range (IQR) 5.0-9.0) versus 8.0 days (IQR 6.0-11.0); p<0.001). Length of hospital stay in the intervention group was significantly shorter (8.0 days (IQR 7.0-11.0) versus 9.0 days (IQR 7.0-12.0; p <0.001) and the cost of hospitalization in the intervention group was significantly lower ($1804.7 (IQR 1298.4-2633.8) versus $2042.5 (IQR 1427.4-2926.2); p 0.002) than control group. More patients in the intervention group achieved de-escalation within 72 hours (7.9%, 29/367 versus 3.2%, 12/377; p 0.005) and between 72 hours and 7 days (29.7%, 109/367 versus 22.0%, 83/377; p 0.024). Conclusions: Use of molecular POCT testing for respiratory viruses and atypical pathogens might help to reduce intravenous antibiotic use in hospitalized LRTI patients. (C) 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
基金：
National Science Grant for Distinguished Young Scholars [81425001/H0104]; Chinese Academy of Medical Science Innovation Fund for Medical Sciences [2018-I2M-1-003]
第一作者单位：[1]Xuanwu Hospital of Capital Medical University, Beijing, China[2]Department of Pulmonary and Critical Care Medicine, ChinaeJapan Friendship Hospital, Beijing, China[3]Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
共同第一作者：
通讯作者：
通讯机构：[2]Department of Pulmonary and Critical Care Medicine, ChinaeJapan Friendship Hospital, Beijing, China[5]Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China[6]National Clinical Research Centre of Respiratory Diseases, Beijing, China[8]Laboratory of Clinical Microbiology and Infectious Diseases, China-Japan Friendship Hospital, Beijing, China[9]Clinical Centre for Pulmonary Infections, Capital Medical University, Beijing, China[10]Tsinghua UniversityePeking University Joint Centre for Life Sciences, Beijing, China[*1]Department of Respiratory and Critical Care Medicine, ChinaeJapan Friendship Hospital, No 2 Ying Hua Yuan Dongjie, Chao Yang District, Beijing 100029, China
推荐引用方式(GB/T 7714)：
Shengchen D.,Gu X.,Fan G.,et al.Evaluation of a molecular point-of-care testing for viral and atypical pathogens on intravenous antibiotic duration in hospitalized adults with lower respiratory tract infection: a randomized clinical trial[J].CLINICAL MICROBIOLOGY and INFECTION.2019,25(11):1415-1421.doi:10.1016/j.cmi.2019.06.012.
APA：
Shengchen, D.,Gu, X.,Fan, G.,Sun, R.,Wang, Y....&Cao, B..(2019).Evaluation of a molecular point-of-care testing for viral and atypical pathogens on intravenous antibiotic duration in hospitalized adults with lower respiratory tract infection: a randomized clinical trial.CLINICAL MICROBIOLOGY and INFECTION,25,(11)
MLA：
Shengchen, D.,et al."Evaluation of a molecular point-of-care testing for viral and atypical pathogens on intravenous antibiotic duration in hospitalized adults with lower respiratory tract infection: a randomized clinical trial".CLINICAL MICROBIOLOGY and INFECTION 25..11(2019):1415-1421
医学