Background Evidence about the clinical impact of rapid diagnostic tests (RDT) for the diagnosis of bloodstream infections is limited, and whether RDT are superior to conventional blood cultures (BC) embedded within antimicrobial stewardship programs (ASP) is unknown. Methods We performed network meta-analyses (NMA) using results from studies of patients with bloodstream infection with the aim of comparing the clinical impact of RDT (applied on positive BC broth or whole blood) to conventional BC, both assessed with and without ASP with respect to mortality, length of stay (LOS) and time to optimal therapy (TOT). Results Eighty-eight papers were selected, including 25,682 patient encounters. There was an appreciable amount of statistical heterogeneity within each meta-analysis. The NMA showed a significant reduction in mortality associated with the use of RDT + ASP vs BC alone (OR 0.72, 95%CI 0.59, 0.87) and with the use of RDT + ASP vs BC + ASP (OR 0.78 95%CI 0.63, 0.96). No benefit in survival was found associated with the use of RDT alone nor with BC + ASP compared to BC alone. A reduction in LOS was associated with RDT + ASP vs BC alone (0.91, 95%CI 0.84, 0.98) while no difference in LOS was shown between any other groups. A reduced TOT was shown when RDT + ASP was compared to BC alone (-29 h, 95%CI -35, -23), BC + ASP (-18 h, 95%CI -27, -10) and to RDT alone (-12 h, 95%CI -20, -3). Conclusion The use of RDT + ASP may lead to a survival benefit even when introduced in settings already adopting effective ASP in association with conventional BC.

中文翻译：

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用于血流感染管理的快速诊断测试和抗菌药物管理计划：它们对改善临床结果的相对贡献是什么？系统综述和网络荟萃分析

背景 关于快速诊断测试（RDT）对诊断血流感染的临床影响的证据有限，并且 RDT 是否优于抗菌管理计划（ASP）中的传统血培养（BC）尚不清楚。方法 我们利用血流感染患者的研究结果进行了网络荟萃分析 (NMA)，目的是比较 RDT（应用于阳性 BC 肉汤或全血）与传统 BC 的临床影响，无论是否使用 ASP 进行评估死亡率、住院时间 (LOS) 和最佳治疗时间 (TOT)。结果 共选出 88 篇论文，包括 25,682 例患者就诊。每个荟萃分析中都存在明显的统计异质性。 NMA 显示，与单独使用 BC 相比，使用 RDT + ASP 与单独使用 BC 相关的死亡率显着降低（OR 0.72，95% CI 0.59、0.87），以及使用 RDT + ASP 与 BC + ASP 相比（OR 0.78，95% CI 0.63， 0.96）。与单独使用 BC 相比，单独使用 RDT 或 BC + ASP 均未发现与生存相关的益处。与单独 BC 相比，RDT + ASP 与 LOS 降低相关（0.91，95%CI 0.84，0.98），而任何其他组之间的 LOS 没有显示差异。当 RDT + ASP 与单独的 BC (-29 h, 95% CI -35, -23)、BC + ASP (-18 h, 95% CI -27, -10) 和单独的 RDT 相比时，显示 TOT 降低（-12 小时，95%CI -20，-3）。结论 即使在已经采用有效 ASP 与传统 BC 结合的环境中，使用 RDT + ASP 也可能带来生存获益。