Open AccessClinical impact of matrix‐assisted laser desorption ionization‐time of flight mass spectrometry combined with antimicrobial stewardship interventions in patients with bloodstream infections in a Japanese tertiary hospital
Author(s) -
Niwa Takashi,
Yonetamari Jun,
Hayama Nozomi,
Fujibayashi Ayasa,
ItoTakeichi Syuri,
Suzuki Keiko,
Ohta Hirotoshi,
Niwa Ayumi,
Tsuchiya Mayumi,
Yamamoto Masayo,
Hatakeyama Daijiro,
Hayashi Hideki,
Obara Michiko,
Sugiyama Tadashi,
Baba Hisashi,
Suzuki Akio,
Murakami Nobuo
Publication year - 2019
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.13332
Subject(s) - medicine , antimicrobial stewardship , antimicrobial , hazard ratio , prospective cohort study , bloodstream infection , intensive care medicine , antibiotics , confidence interval , microbiology and biotechnology , antibiotic resistance , biology
Summary Background Matrix‐assisted laser desorption ionization‐time of flight mass spectrometry ( MALDI ‐ TOF MS ) has the potential to permit early organism identification and optimization of antibiotic therapy. However, MALDI ‐ TOF MS combined with antimicrobial stewardship is available at only a limited number of institutions. Here, we evaluated the clinical impact of implementing MALDI ‐ TOF MS combined with antimicrobial stewardship intervention in patients with bloodstream infections. Methods We conducted a single‐centre, prospective cohort study to evaluate the clinical impact of implementing MALDI ‐ TOF MS combined with antimicrobial stewardship intervention in patients with bloodstream infections. Processes and clinical outcomes in patients with bloodstream infections were compared before and after implementation of MALDI ‐ TOF MS . Results Compared with the conventional identification method, MALDI ‐ TOF MS combined with antimicrobial stewardship intervention significantly decreased the time to organism identification (48.6 ± 46.0 hours vs 78.1 ± 38.9 hours, P < 0.001), effective antimicrobial therapy (12.9 ± 19.0 hours vs 26.2 ± 44.8 hours, P < 0.001) and optimal antimicrobial therapy (53.3 ± 55.0 hours vs 91.7 ± 88.7 hours, P < 0.001. Moreover, the rate of clinical failure (14.0% vs 33.3%, P < 0.001) and incidence of adverse events (7.5% vs 23.9%, P < 0.001) was lower in the MALDI ‐ TOF MS group than in the conventional identification group. A multivariate Cox proportional hazard analysis indicated that implementation of MALDI ‐ TOF MS was a protective factor against clinical failure in patients with bloodstream infections (hazard ratio, 0.61; 95% confidence interval, 0.38‐0.99; P = 0.047). Conclusions Implementation of the MALDI ‐ TOF MS combined with antimicrobial stewardship intervention facilitated early optimization of antimicrobial therapy with a remarkable concomitant reduction in clinical failure and adverse events in patients with bloodstream infections.