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Diagnostic stewardship for sepsis: the need for risk stratification to triage patients for fast microbiology workflows

    Davide Mangioni

    Department of Infectious and Tropical Diseases, ASST Spedali Civili General Hospital - University of Brescia, Brescia, Italy

    Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico - University of Milan, Milan, Italy

    Authors contributed equally

    Search for more papers by this author

    ,
    Bruno Viaggi

    Department of Anesthesiology, Neuro Intensive Care Unit, Florence Careggi University Hospital, Florence, Italy

    Authors contributed equally

    Search for more papers by this author

    ,
    Tommaso Giani

    Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy

    ,
    Fabio Arena

    Department of Medical Biotechnologies, University of Siena, Siena, Italy

    ,
    Sara D'Arienzo

    Tuscan Regional Health Agency, Florence, Italy

    ,
    Silvia Forni

    Tuscan Regional Health Agency, Florence, Italy

    ,
    Giorgio Tulli

    Tuscan Regional Health Agency, Florence, Italy

    &
    Gian M Rossolini

    *Author for correspondence:

    E-mail Address: gianmaria.rossolini@unifi.it

    Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy

    Published Online:https://doi.org/10.2217/fmb-2018-0329
    Free first page

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

    References

    • 1 Rhodes A, Evans LE, Alhazzani W et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 43(3), 304–377 (2017).
    • 2 Carrara E, Pfeffer I, Zusman O, Leibovici L, Paul M. Determinants of inappropriate empirical antibiotic treatment: systematic review and meta-analysis. Int. J. Antimicrob. Agents 51(4), 548–553 (2018). • An extensive evaluation of the impact of infections by multidrug-resistant organisms on patient's management and outcomes.
    • 3 Buehler SS, Madison B, Snyder SR et al. Effectiveness of practices to increase timeliness of providing targeted therapy for inpatients with bloodstream infections: a laboratory medicine best practices systematic review and meta-analysis. Clin. Microbiol. Rev. 29(1), 59–103 (2016). •• A comprehensive assessment of different fast microbiology workflows on pathogen identification and initiation of targeted therapy in bloodstream infections.
    • 4 Tabah A, Koulenti D, Laupland K et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT international cohort study. Intensive Care Med. 38(12), 1930–1945 (2012).
    • 5 Dubourg G, Lamy B, Ruimy R. Rapid phenotypic methods to improve the diagnosis of bacterial bloodstream infections: meeting the challenge to reduce the time to result. Clin. Microbiol. Infect. 24(9), 935–943 (2018).
    • 6 Peker N, Couto N, Sinha B, Rossen JW. Diagnosis of bloodstream infections from positive blood cultures and directly from blood samples: recent developments in molecular approaches. Clin. Microbiol. Infect. 24(9), 944–955 (2018). •• An exhaustive update on recent developments of molecular methods in the diagnosis of bloodstream infections.
    • 7 Arena F, Giani T, Pollini S, Viaggi B, Pecile P, Rossolini GM. Molecular antibiogram in diagnostic clinical microbiology: advantages and challenges. Future Microbiol. 12, 361–364 (2017).
    • 8 Bookstaver PB, Nimmich EB, Smith TJ et al. Cumulative effect of an antimicrobial stewardship and rapid diagnostic testing bundle on early streamlining of antimicrobial therapy in gram-negative bloodstream infections. Antimicrob. Agents Chemother. 61(9), e00189–17 (2017).
    • 9 Barlam TF, Cosgrove SE, Abbo LM et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin. Infect. Dis. 62(10), e51–e77 (2016).
    • 10 Menichetti F, Falcone M, Lopalco P et al. The GISA call to action for the appropriate use of antimicrobials and the control of antimicrobial resistance in Italy. Int. J. Antimicrob. Agents. 52(2), 127–134 (2018).
    • 11 US Food and Drug Association. Companion Diagnostics (2018). www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/InVitroDiagnostics/ucm407297.htm.
    • 12 Messacar K, Parker SK, Todd JK, Dominguez SR. Implementation of rapid molecular infectious disease diagnostics: the role of diagnostic and antimicrobial stewardship. J. Clin. Microbiol. 55(3), 715–723 (2017). •• An overview of features and aims of diagnostic stewardship and its connection to antimicrobial stewardship.
    • 13 Vincent JL, De Mendonça A, Cantraine F et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Crit. Care Med. 26(11), 1793–1800 (1998).
    • 14 Quan H, Li B, Couris CM et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am. J. Epidemiol. 173(6), 676–682 (2011).
    • 15 Singer M, Deutschman CS, Seymour CW et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315(8), 801–810 (2016).
    • 16 Russo A, Falcone M, Gutiérrez-Gutiérrez B et al. Predictors of outcome in patients with severe sepsis or septic shock due to extended-spectrum β-lactamase-producing Enterobacteriaceae. Int. J. Antimicrob. Agents 52(5), 577–585 (2018).
    • 17 Rhee JY, Kwon KT, Ki HK et al. Scoring systems for prediction of mortality in patients with intensive care unit-acquired sepsis: a comparison of the PITT bacteremia score and the Acute Physiology and Chronic Health Evaluation II scoring systems. Shock 31(2), 146–150 (2009).
    • 18 Chen C, Yan M, Hu C, Lv X, Zhang H, Chen S. Diagnostic efficacy of serum procalcitonin, C-reactive protein concentration and clinical pulmonary infection score in ventilator-associated pneumonia. Med. Sci. 34, 26–32 (2018).
    • 19 Scudeller L, Bassetti M, Concia E et al. Medical wards invasive candidiasis algorithms (MEDICAL): consensus proposal for management. Eur. J. Intern. Med. 34, 45–53 (2016).
    • 20 Dickstein Y, Edelman R, Dror T, Hussein K, Bar-Lavie Y, Paul M. Carbapenem-resistant Enterobacteriaceae colonization and infection in critically ill patients: a retrospective matched cohort comparison with non-carriers. J. Hosp. Infect. 94(1), 54–59 (2016). • Clinical study assessing the association of carbapenem-resistant Enterobacterales colonization with the risk of infection by the colonizing strain.
    • 21 Wirz Y, Meier MA, Bouadma L et al. Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials. Crit. Care 22(1), 191 (2018).
    • 22 Bartoletti M, Antonelli M, Blasi FAB et al. Procalcitonin-guided antibiotic therapy: an expert consensus. Clin. Chem. Lab. Med. 56(8), 1223–1229 (2018).
    • 23 Viaggi B, Poole D, Tujjar O, Marchiani S, Ognibene A, Finazzi S. Mid regional pro-adrenomedullin for the prediction of organ failure in infection. Results from a single centre study. PLoS ONE 13(8), e0201491 (2018). • Clinical study on the ability of the novel biomarker mid-regional proadrenomedullin in predicting the evolution to sepsis of infected patients in intensive care unit.
    • 24 Roberts JA, Abdul-Aziz MH, Lipman J et al. Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions. Lancet Infect. Dis. 14(6), 498–509 (2014).