Tesis doctoral de Alicia Galar Recalde
Clinical utility of information provided by the microbiology laboratory is sometimes reduced by the length of time it takes to generate that information. Up to 50% of the antibiotic prescriptions in the hospital are considered inappropriate. The aim of this study was to measure the clinical and economic impact of rapid microbiological information. 574 hospitalized patients with a bacterial clinical infection confirmed by culture were evaluated. The control group (results information in the following day of their obtaining; retrospective study) contained 284 hospitalized patients and the intervention group (results information in the same day; prospective study) 290. Vitek® 2 system (biomérieux) was used for identification and antimicrobial susceptibility testing in both groups. Outcome parameters were antibiotic use, length of hospital stay, number of procedures performed, days under invasive mechanic ventilation and mortality rates. It was also considered direct fixed costs, direct variable costs and indirect costs during hospitalization. Treatment recommendations were made by an infectious diseases physician. Faster reporting of microbiological results enabled the clinician to optimize the antibiotic treatment sooner (p<0.001), which was associated with an improved clinical outcome. This reduction of turnaround time led to a reduction in the length of hospitalization (p=0.002), the number of microbiological (p=0.039) and biochemical (p=0.038) tests performed, as well as the number of blood glucose (p=0.021) and pcr (p<0.001) determinations. Intubation requirements were also lower in the intervention group (p=0.001) compared with the control group. Mortality rates did not differ significantly between the two groups. Costs incurred by patients in the intervention group were lower than those in the control group with respect to laboratory costs (p=0.002), microbiology costs (p=0.007), antibiotic costs (p=0.043), length of hospitalization (p=0.001) and ¿other costs¿ (blood bank, anesthesia, clinical assistance and operating room) (p=0.001). The total mean cost of hospitalization in the intervention group (25,030 ¿) was significantly lower than the total mean cost of hospitalization in the control group (28,280 ¿) (p=0.023). This supposed a cost savings of 3,250 ¿ per patient. Clinical and economic impact of rapid microbiological information of bacterial blood culture isolates was lower than that of the exudates and abscesses cultures and the genito-urinary tract samples cultures.
Datos académicos de la tesis doctoral «Impacto clínico y económico de la información rápida microbiológica«
- Título de la tesis: Impacto clínico y económico de la información rápida microbiológica
- Autor: Alicia Galar Recalde
- Universidad: Navarra
- Fecha de lectura de la tesis: 02/07/2010
Dirección y tribunal
- Director de la tesis
- Jose Leiva León
- Tribunal
- Presidente del tribunal: Francisco Guillen grima
- Mª soledad Salvo gonzalo (vocal)
- marina de Cueto lopez (vocal)
- Alberto Pahissa berga (vocal)