Antimicrobial stewardship in long term care facilities: what is effective?
Antimicrobial stewardship in long term care facilities: what is effective?
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DOI：
10.1186/2047-2994-3-6
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发表时间：
2014-02-12
影响因子：
5.5
通讯作者：
Nicolle LE
中科院分区：
文献类型：
--
作者：
Nicolle LE
长期护理设施中大量使用抗菌剂会促进抗菌素耐药微生物的出现和持续，并导致艰难梭菌结肠炎等不良反应。指南建议为这些设施制定抗菌药物管理计划，以促进抗菌药物的最佳使用。然而，这些计划的有效性或任何特定计划组成部分的贡献尚不清楚。在这篇综述中，通过系统的文献搜索确定了描述长期护理机构抗菌药物管理计划评估的出版物。干预措施包括教育、指南制定、对从业人员的反馈和传染病咨询。审查的研究在设施类型、使用的干预措施、实施和评估方面各不相同。据报道，针对所有感染的综合方案改善了抗菌剂的使用，至少取得了一些结果。有针对性的肺炎治疗方案效果甚微，而且只适用于与管理不确定相关的指标。据报道，侧重于治疗尿路感染的具体方面的方案--限制无症状菌尿的治疗或预防尿路感染--是有效的。目前还没有关于成本效益的报告，而且大多数项目的可持续性尚不清楚。有必要进行进一步的评估，以确定长期护理机构有效的抗菌素管理。
Intense antimicrobial use in long term care facilities promotes the emergence and persistence of antimicrobial resistant organisms and leads to adverse effects such as C. difficile colitis. Guidelines recommend development of antimicrobial stewardship programs for these facilities to promote optimal antimicrobial use. However, the effectiveness of these programs or the contribution of any specific program component is not known. For this review, publications describing evaluation of antimicrobial stewardship programs for long term care facilities were identified through a systematic literature search. Interventions included education, guidelines development, feedback to practitioners, and infectious disease consultation. The studies reviewed varied in types of facilities, interventions used, implementation, and evaluation. Comprehensive programs addressing all infections were reported to have improved antimicrobial use for at least some outcomes. Targeted programs for treatment of pneumonia were minimally effective, and only for indicators of uncertain relevance for stewardship. Programs focusing on specific aspects of treatment of urinary infection – limiting treatment of asymptomatic bacteriuria or prophylaxis of urinary infection – were reported to be effective. There were no reports of cost-effectiveness, and the sustainability of most of the programs is unclear. There is a need for further evaluation to characterize effective antimicrobial stewardship for long term care facilities.
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影响因子：
4.5
作者：
Jump RL;Olds DM;Seifi N;Kypriotakis G;Jury LA;Peron EP;Hirsch AA;Drawz PE;Watts B;Bonomo RA;Donskey CJ
通讯作者：
Donskey CJ
DOI：
10.1111/j.1532-5415.2007.01251.x
发表时间：
2007-08-01
影响因子：
6.3
作者：
Schwartz, David N.;Abiad, Homer;Weinstein, Robert A.
通讯作者：
Weinstein, Robert A.
影响因子：
--
作者：
Loeb, M;Brazil, K;Walter, SD
通讯作者：
Walter, SD
DOI：
10.1111/j.1532-5415.2007.01250.x
发表时间：
2007-08-01
影响因子：
6.3
作者：
Monette, Johanne;Miller, Mark A.;Cotton-Montpetit, Marie
通讯作者：
Cotton-Montpetit, Marie
DOI：
10.1016/j.amjopharm.2011.09.009
发表时间：
2011-12-01
期刊：
AMERICAN JOURNAL OF GERIATRIC PHARMACOTHERAPY
影响因子：
--
作者：
Linnebur, Sunny A.;Fish, Douglas N.;Hutt, Evelyn
通讯作者：
Hutt, Evelyn