Antimicrobial stewardship across 47 South African hospitals: an implementation study
Antimicrobial stewardship across 47 South African hospitals: an implementation study
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DOI：
10.1016/s1473-3099(16)30012-3
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发表时间：
2016-09-01
影响因子：
56.3
通讯作者：
van den Bergh, Dena
中科院分区：
文献类型：
--
作者：
Brink, Adrian J.;Messina, Angeliki P.;van den Bergh, Dena
背景关于非洲抗菌素管理方案的现有数据很少。这项研究的目的是评估在传染病资源有限的情况下抗菌药物管理计划的实施情况。方法我们在南非不同的城市和农村私立医院群中，根据一系列改进科学和行为原则，实施了药剂师驱动的前瞻性审计和反馈策略。这项研究有一个实施前阶段，在此期间对基线管理活动进行了调查。此后，针对减少抗生素消费的过程措施(延长疗程、多种抗生素和多余的抗生素覆盖范围)启动了分阶段实施阶段，然后在模型嵌入每家医院后进入实施后阶段。使用WHO定义的每100患者日剂量指数评估对消耗的影响，并使用线性混合效应回归模型评估主要结果(阶段之间抗生素消耗的变化)。结果我们在2009年10月1日至2014年9月30日期间实施并评估了抗菌药物管理计划。在104周的标准化测量和反馈期间，47家医院的116 662名患者接受了抗生素治疗，5项有针对性的措施记录了7934名药剂师的干预措施，这表明几乎每15张处方中就有1张需要干预。在7934名药师干预中，有3116名(39%)的干预持续时间过长。抗菌药物管理计划导致每百病人日平均抗生素定义剂量从实施前阶段的101.38(95%可信区间93.05-109.72)下降到实施后阶段的83.04%(74.8791.22)(p
Background The available data on antimicrobial stewardship programmes in Africa are scarce. The aims of this study were to assess the implementation of an antimicrobial stewardship programme in a setting with limited infectious disease resources.Methods We implemented a pharmacist-driven, prospective audit and feedback strategy for antimicrobial stewardship on the basis of a range of improvement science and behavioural principles across a diverse group of urban and rural private hospitals in South Africa. The study had a pre-implementation phase, during which a survey of baseline stewardship activities was done. Thereafter, a stepwise implementation phase was initiated directed towards auditing process measures to reduce consumption of antibiotics (prolonged duration, multiple antibiotics, and redundant antibiotic coverage), followed by a post-implementation phase once the model was embedded in each hospital. The effect on consumption was assessed with the WHO index of defined daily doses per 100 patient days, and the primary outcome (change in antibiotic consumption between phases) was assessed with a linear mixed-effects regression model.Findings We implemented and assessed the antimicrobial stewardship programme between Oct 1, 2009, and Sept 30, 2014. 116 662 patients receiving antibiotics at 47 hospitals during 104 weeks of standardised measurement and feedback, were reviewed, with 7934 interventions by pharmacists recorded for the five targeted measures, suggesting that almost one in 15 prescriptions required intervention. 3116 (39%) of 7934 pharmacist interventions were of an excessive duration. The antimicrobial stewardship programme led to a reduction in mean antibiotic defined daily doses per 100 patient days from 101.38 (95% CI 93.05-109.72) in the pre-implementation phase to 83.04 (74.87-91.22) in the post-implementation phase (p