Clinical Utility of Rapid Pathogen Identification for Detecting the Causative Organisms in Sepsis: A Single-Center Study in Korea

초록

Purpose. The aim of this pre- and postintervention cohort study was evaluating how effectively rapid pathogen identification with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) detected the causative organisms in sepsis. Methods. All consecutive adult patients who had bacteremia within 72 h of intensive care unit admission and met >= 2 quick Sequential Organ Failure Assessment criteria at intensive care unit admission were analyzed. The patients whose microorganisms were identified via MALDI-TOF MS between March 2014 and February 2016 formed the postintervention group. The patients whose microorganisms were identified by using conventional methods between March 2011 and February 2013 formed the preintervention group. Results. The postintervention group (n = 58) had a shorter mean time from blood draw to receiving the antimicrobial susceptibility results than the preintervention group (n = 40) (90.2 +/- 32.1 vs. 108.7 +/- 43.1 h; p = 0.02). The postintervention group was also more likely to have received active antimicrobial therapy by the time the susceptibility report became available (77% vs. 47%; p = 0.005). Its 28-day mortality was also lower (40% vs. 70%; p = 0.003). Univariate analysis showed that identification via MALDI-TOF MS (odds ratio, 0.28; 95% confidence interval, 0.12-0.66; p = 0.004) and active therapy (odds ratio, 0.38; 95% confidence interval, 0.16-0.95; p = 0.04) were associated with lower 28-day mortality. Conclusion. Rapid microorganism identification via MALDI-TOF MS followed by appropriate antimicrobial therapy may improve the clinical outcomes of patients with sepsis.

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