捕捉“危险的虫子”

A new study led by a student from 365英国上市官网 William Beaumont School of Medicine suggests there’s a better way to help doctors decide when to give patients strong antibiotics.

“Combining DRIP Score and Rapid Diagnostics for Improved Antibiotic Stewardship,是由理查德·拉米雷斯领导的, 一名四年级医科学生.

共同作者是马修·西姆斯，M.D., Ph.D., 牛津大学内科学副教授, 传染病研究中心主任, Corewell Health East, 还有阿莱姆·菲特, Ph.D., an infectious diseases researcher at Corewell Health William Beaumont University Hospital in Royal Oak.

拉米雷斯和西姆斯在华盛顿特区介绍了这项工作.C., 在IDWeek, the joint annual meeting of the Infectious Diseases Society of America, 美国卫生保健流行病学学会, 艾滋病医学协会, 儿童传染病学会, 以及传染病药剂师协会.

通过研究, the team essentially sought to determine if a better system could be developed for deciding when patients should be treated with broad-spectrum antibiotics, 这是有效的, 但也有风险.

“One of the first decisions a clinician has to make is whether or not to put the patient on broad-spectrum antibiotics,拉米雷斯说. “这是一个非常艰难的决定.”

捕捉“危险的虫子”

Broad-spectrum antibiotics fight against a wide array of disease-causing bacteria. 然而, 广谱抗生素也会带来特定的风险, 尤其是对原生的破坏, 正常的细菌, 以及超级细菌的潜在发展, 或者细菌菌株, 病毒, 寄生虫, 真菌对大多数抗生素都有抗药性.

The study took into account two methods doctors use to help them decide when they should or shouldn’t use the medications.

A Drug Resistance in Pneumonia (DRIP) score is one of the methods used to determine when to use broad-spectrum antibiotics. The score is based on patient answers to several key questions on factors such as if the patient has been on antibiotics in the last 60 days, 目前还有其他药物吗, 等等.......

“The DRIP score is a very simple way to say ‘This patient likely needs broad-spectrum antibiotics,’ or ‘This patient likely doesn’t need broad-spectrum anti-biotics,’”西姆斯说.

这个问题, 拉米雷斯说, is that using the DRIP score to determine use of the anti-biotics can lead to patients taking strong antibiotics they may not need.

“You can have a patient who needs one very simple drug taking three or four different ones,他说.

Enter the other method used by doctors to determine when to use a broad-spectrum antibiotics regimen: a Unyvero Lower Respiratory Tract Infection (LRTI) panel.

An LRTI is a newer rapid diagnostic tool that can determine within hours exactly what bugs a patient has, which allows doctors to know if they should use broad-spectrum anti-biotics, 或者他们能不能少用点.

An LRTI also finds specific pathogens and resistances that require antibiotics beyond vancomycin and anti-pseudomonals.

这个问题 with LRTI panels, however, is that they are very expensive. Not only that, but they are too often used on patients found not to have pneumonia.

正如西姆斯所说 传染生活, the costs and higher number of negatives put doctors in the tough position of having to decide when to roll the dice and use LRTI panels.

“What we wanted to do was look at how do we improve this…to make it more likely that the people you use (LRTI panels) on are the right people,他说.

The study led by Ramirez looked at aggregate data from 442 patients who participated in the LRTI panel clinical trial locally.

拉米雷斯说，通过查看数据, the team was able to develop an algorithm that essentially would qualify patients for an LRTI panel if their DRIP score meets a certain threshold.

“到医院, what we’re saying is that if you use the DRIP score to stratify patients that use the more expensive (LRTI panel) on, you will catch the vast majority of dangerous bugs and be able to treat them specifically within hours instead of having a patient unnecessarily on all these extra drugs for multiple days,拉米雷斯说.

“一次奇妙的经历”

拉米雷斯通过OUWB的Embark项目领导了这项研究.

Embark is a required scholarly concentration program that provides a mentored introduction to research and scholarship. The four-year longitudinal curriculum consists of structured coursework in research design and implementation, 合规培训, 研究交流, 学术性的陈述, with protected time to develop mentored projects in a wide-range of community and health-related settings.

Ramirez said he enjoyed being part of the research project from the start, 这对他将来有帮助吗.

“I got to really get an idea of the complexity of getting a study started, 填写所有的文件, 深入到如何呈现数据的具体细节, 以及如何验证数据,他说. “这让我大开眼界.”

Being able to present the work 在IDWeek, he said, was “an incredible experience.”

“太神奇了，”他说. “You have all the leaders in the field there…names you see in all of the papers and now you’re there among them. 让人难以置信.”