The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities
The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities
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DOI：
10.1017/ice.2018.237
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发表时间：
2018-12-01
影响因子：
4.5
通讯作者：
Rosen, Sophia
中科院分区：
文献类型：
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作者：
D'Agata, Erika M. C.;Lindberg, Curt C.;Rosen, Sophia
背景：抗菌药物管理计划可有效优化抗菌药物处方模式并减少抗菌药物暴露的负面后果，包括多重耐药微生物的出现。在透析设施中，30%-35% 的抗菌药物要么没有指定，要么抗菌药物的类型不是最佳的。尽管抗菌药物管理计划现已在全国范围内的医院环境中实施，但尚未制定针对维持性透析设施的具体计划。目的：量化抗菌药物管理计划在减少抗菌药物处方方面的效果。研究设计和背景：在 6 个门诊血液透析设施中进行了一项间断时间序列研究，将计划实施前 12 个月内每 100 名患者每月的平均抗菌药物剂量与 12 个月干预期间的剂量进行了比较结果：实施抗菌药物管理计划与干预期间每 100 名患者月的抗菌药物剂量每月减少 6% 相关 (P=.02)。干预结束时，最初每 100 名患者月 22.6 次抗菌药物剂量的平均值下降至每 100 名患者月 10.5 次抗菌药物剂量的平均值。按类型（包括万古霉素）的抗菌药物使用情况没有显着变化。建议对 145 个抗菌疗程中的 30 个疗程（20.6%）进行抗菌药物调整，这些疗程有足够的临床数据。最常见的调整原因包括治疗甲氧西林敏感金黄色葡萄球菌感染时从万古霉素降级为头孢唑林，以及在不符合假定感染标准时停止抗菌药物。结论：在 6 个血液透析机构中，抗菌药物管理的实施与抗菌药物处方量的减少相关，但没有负面影响。
Background: Antimicrobial stewardship programs are effective in optimizing antimicrobial prescribing patterns and decreasing the negative outcomes of antimicrobial exposure, including the emergence of multidrug-resistant organisms. In dialysis facilities, 30%-35% of antimicrobials are either not indicated or the type of antimicrobial is not optimal. Although antimicrobial stewardship programs are now implemented nationwide in hospital settings, programs specific to the maintenance dialysis facilities have not been developed.Objective: To quantify the effect of an antimicrobial stewardship program in reducing antimicrobial prescribing.Study design and setting: An interrupted time-series study in 6 outpatient hemodialysis facilities was conducted in which mean monthly antimicrobial doses per 100 patient months during the 12 months prior to the program were compared to those in the 12-month intervention period.Results: Implementation of the antimicrobial stewardship program was associated with a 6% monthly reduction in antimicrobial doses per 100 patient months during the intervention period (P=.02). The initial mean of 22.6 antimicrobial doses per 100 patient months decreased to a mean of 10.5 antimicrobial doses per 100 patient months at the end of the intervention. There were no significant changes in antimicrobial use by type, including vancomycin. Antimicrobial adjustments were recommended for 30 of 145 antimicrobial courses (20.6%) for which there were sufficient clinical data. The most frequent reasons for adjustment included de-escalation from vancomycin to cefazolin for methicillin-susceptible Staphylococcus aureus infections and discontinuation of antimicrobials when criteria for presumed infection were not met.Conclusions: Within 6 hemodialysis facilities, implementation of an antimicrobial stewardship was associated with a decline in antimicrobial prescribing with no negative effects.