Biofire FilmArray Meningitis/Encephalitis panel for the aetiological diagnosis of central nervous system infections: A systematic review and diagnostic test accuracy meta-analysis / Santiago León Atehortúa Muñoz    

Público ISBD Título : Biofire FilmArray Meningitis/Encephalitis panel for the aetiological diagnosis of central nervous system infections: A systematic review and diagnostic test accuracy meta-analysis Tipo de documento : documento electrónico Autores : Santiago León Atehortúa Muñoz, Fecha de publicación : 2022 Títulos uniformes : eClinicalMedicine Idioma : Inglés (eng) Palabras clave : CNS infection  Diagnostic accuracy  Encephalitis  Film array  Meningitis  Meta-analysis  Multiplex PCR Resumen : Background: The FilmArray Meningitis/Encephalitis(FA/ME) panel brings benefits in clinical practice, but its diagnostic test accuracy (DTA) remains unclear. We aimed to determine the DTA of FA/ME for the aetiological diagnostic in patients with suspected central nervous system(CNS) infection. Methods: We performed a systematic review with DTA meta-analysis (PROSPERO: CRD42020139285). We searched Embase, Medline (Ovid), and Web of Science from inception until September 1st, 2021. We assessed the study-level risk of bias with the QUADAS-2 tool and applied the GRADE approach to assess the certainty of the synthesised evidence. We included studies that simultaneously measured the reference test (CSF/blood culture for bacteria, and specific polymerase chain reaction for viruses) and the FA/ME in patients with suspected CNS infection. We performed random-effects bivariate meta-analysis models of combined sensitivity and specificity using CSF/blood cultures(reference test 1) and a final diagnosis adjudication based on clinical/laboratory criteria (reference test 2). Findings: We included 19 studies (11,351 participants). For all bacteria with reference test 1 (16 studies/6183 patients) sensitivity was estimated at 89·5% (95%CI 81·1-94·4), and specificity at 97·4% (95%CI 94-98·9). With reference test 2 (15 studies/5,524 patients), sensitivity was estimated at 92·1%(95%CI 86·8-95·3) and specificity at 99.2(95%CI 98·3-99·6) For herpes simplex virus-2(HSV-2), enteroviruses, and Varicella-Zoster virus (VZV), we obtained sensitivities between 75·5 and 93·8%, and specificities above 99% (reference test 1). Certainty of the evidence was low. Interpretation: FA/ME may have acceptable-to-high sensitivities and high specificities for identifying bacteria, especially for S.pneumoniae, and viruses, especially for HSV-2, and enteroviruses. Sensitivities for L.monocytogenes, H.influenzae, E.coli, and HSV-1 were suboptimal. Mención de responsabilidad : Juliana Trujillo-Gomez, Sofia Tsokani, Catalina Arango-Ferreira, Santiago Atehortua-Muñoz, Maria José Jimenez-Villegas, Carolina Serrano-Tabares, Areti-Angeliki Veroniki, and Ivan D. Florez Referencia : EClinicalMedicine. 2022 Feb 14;44:101275. DOI (Digital Object Identifier) : 10.1016/j.eclinm.2022.101275 PMID : 35198914 Derechos de uso : CC BY-NC-ND En línea : https://linkinghub.elsevier.com/retrieve/pii/S2589537022000050 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=6011 Biofire FilmArray Meningitis/Encephalitis panel for the aetiological diagnosis of central nervous system infections: A systematic review and diagnostic test accuracy meta-analysis [documento electrónico] / Santiago León Atehortúa Muñoz,  . - 2022. Obra : eClinicalMedicine Idioma : Inglés (eng) Palabras clave : CNS infection  Diagnostic accuracy  Encephalitis  Film array  Meningitis  Meta-analysis  Multiplex PCR Resumen : Background: The FilmArray Meningitis/Encephalitis(FA/ME) panel brings benefits in clinical practice, but its diagnostic test accuracy (DTA) remains unclear. We aimed to determine the DTA of FA/ME for the aetiological diagnostic in patients with suspected central nervous system(CNS) infection. Methods: We performed a systematic review with DTA meta-analysis (PROSPERO: CRD42020139285). We searched Embase, Medline (Ovid), and Web of Science from inception until September 1st, 2021. We assessed the study-level risk of bias with the QUADAS-2 tool and applied the GRADE approach to assess the certainty of the synthesised evidence. We included studies that simultaneously measured the reference test (CSF/blood culture for bacteria, and specific polymerase chain reaction for viruses) and the FA/ME in patients with suspected CNS infection. We performed random-effects bivariate meta-analysis models of combined sensitivity and specificity using CSF/blood cultures(reference test 1) and a final diagnosis adjudication based on clinical/laboratory criteria (reference test 2). Findings: We included 19 studies (11,351 participants). For all bacteria with reference test 1 (16 studies/6183 patients) sensitivity was estimated at 89·5% (95%CI 81·1-94·4), and specificity at 97·4% (95%CI 94-98·9). With reference test 2 (15 studies/5,524 patients), sensitivity was estimated at 92·1%(95%CI 86·8-95·3) and specificity at 99.2(95%CI 98·3-99·6) For herpes simplex virus-2(HSV-2), enteroviruses, and Varicella-Zoster virus (VZV), we obtained sensitivities between 75·5 and 93·8%, and specificities above 99% (reference test 1). Certainty of the evidence was low. Interpretation: FA/ME may have acceptable-to-high sensitivities and high specificities for identifying bacteria, especially for S.pneumoniae, and viruses, especially for HSV-2, and enteroviruses. Sensitivities for L.monocytogenes, H.influenzae, E.coli, and HSV-1 were suboptimal. Mención de responsabilidad : Juliana Trujillo-Gomez, Sofia Tsokani, Catalina Arango-Ferreira, Santiago Atehortua-Muñoz, Maria José Jimenez-Villegas, Carolina Serrano-Tabares, Areti-Angeliki Veroniki, and Ivan D. Florez Referencia : EClinicalMedicine. 2022 Feb 14;44:101275. DOI (Digital Object Identifier) : 10.1016/j.eclinm.2022.101275 PMID : 35198914 Derechos de uso : CC BY-NC-ND En línea : https://linkinghub.elsevier.com/retrieve/pii/S2589537022000050 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=6011

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A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study    

Público ISBD Título : A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study Tipo de documento : documento electrónico Fecha de publicación : 2021 Títulos uniformes : eClinicalMedicine Idioma : Inglés (eng) Palabras clave : Global point prevalence study  Neonatal infection  Neonatal antimicrobial stewardship  Antibiotics  Antifungal Resumen : Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26% of infants (580/2,265; range, 0–100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received ≥1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were “rule-out” sepsis (32%) and “culture-negative” sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and “culture-negative” infections was 12 days (median; IQR, 8–14) and 7 days (median; IQR, 5–10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0·02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. Mención de responsabilidad : Pavel Prusakov, PharmD, Debra A. Goff, PharmD, Phillip S. Wozniak, BA, Azraa Cassim, BPharm, Catherine E.A. Scipion, MD, Soledad Urzua, MD, Andrea Ronchi, MD, Lingkong Zeng, MD, Oluwaseun Ladipo-Ajayi, MBChB, Noelia Aviles-Otero, MD, Chisom R. Udeigwe-Okeke, MBBS, Rimma Melamed, MD, Rita C. Silveira, MD,Cinzia Auriti, MD, Claudia Beltran-Arroyave, MD, Elena Zamora-Flores, MD, Maria Sanchez-Codez, MD, Eric S. Donkor, PhD, Satu Kekomaki, MD, Nicoletta Mainini, MD, Rosalba Vivas Trochez, MD, Jamalyn Casey, PharmD, Juan M. Graus, MD, Mallory Muller, PharmD, Sara Singh, MBBS, Yvette Loeffen, MD, María Eulalia Tamayo Perez, MD, Gloria Isabel Ferreyra, MD, Victoria Lima-Rogel, MD, Barbara Perrone, MD, Giannina Izquierdo, MD, María Cernada, MD, Sylvia Stoffella, PharmD, Sebastian Okwuchukwu Ekenze, MD, Concepcion de Alba-Romero, MD, Chryssoula Tzialla, MD, Jennifer T. Pham, PharmD, Kenichiro Hosoi, MD, Magdalena Cecilia Calero Consuegra, MD, Pasqua Betta, MD, O. Alvaro Hoyos, MD, Emmanuel Roi Referencia : EClinicalMedicine. 2021 Jan 29;32:100727. DOI (Digital Object Identifier) : 10.1016/j.eclinm.2021.100727 PMID : 33554094 Derechos de uso : CC BY-NC-ND En línea : https://linkinghub.elsevier.com/retrieve/pii/S2589537021000079 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5860 A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study [documento electrónico] . - 2021. Obra : eClinicalMedicine Idioma : Inglés (eng) Palabras clave : Global point prevalence study  Neonatal infection  Neonatal antimicrobial stewardship  Antibiotics  Antifungal Resumen : Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26% of infants (580/2,265; range, 0–100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received ≥1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were “rule-out” sepsis (32%) and “culture-negative” sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and “culture-negative” infections was 12 days (median; IQR, 8–14) and 7 days (median; IQR, 5–10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0·02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. Mención de responsabilidad : Pavel Prusakov, PharmD, Debra A. Goff, PharmD, Phillip S. Wozniak, BA, Azraa Cassim, BPharm, Catherine E.A. Scipion, MD, Soledad Urzua, MD, Andrea Ronchi, MD, Lingkong Zeng, MD, Oluwaseun Ladipo-Ajayi, MBChB, Noelia Aviles-Otero, MD, Chisom R. Udeigwe-Okeke, MBBS, Rimma Melamed, MD, Rita C. Silveira, MD,Cinzia Auriti, MD, Claudia Beltran-Arroyave, MD, Elena Zamora-Flores, MD, Maria Sanchez-Codez, MD, Eric S. Donkor, PhD, Satu Kekomaki, MD, Nicoletta Mainini, MD, Rosalba Vivas Trochez, MD, Jamalyn Casey, PharmD, Juan M. Graus, MD, Mallory Muller, PharmD, Sara Singh, MBBS, Yvette Loeffen, MD, María Eulalia Tamayo Perez, MD, Gloria Isabel Ferreyra, MD, Victoria Lima-Rogel, MD, Barbara Perrone, MD, Giannina Izquierdo, MD, María Cernada, MD, Sylvia Stoffella, PharmD, Sebastian Okwuchukwu Ekenze, MD, Concepcion de Alba-Romero, MD, Chryssoula Tzialla, MD, Jennifer T. Pham, PharmD, Kenichiro Hosoi, MD, Magdalena Cecilia Calero Consuegra, MD, Pasqua Betta, MD, O. Alvaro Hoyos, MD, Emmanuel Roi Referencia : EClinicalMedicine. 2021 Jan 29;32:100727. DOI (Digital Object Identifier) : 10.1016/j.eclinm.2021.100727 PMID : 33554094 Derechos de uso : CC BY-NC-ND En línea : https://linkinghub.elsevier.com/retrieve/pii/S2589537021000079 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5860

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