Unnecessary use of antimicrobials in hospitalized patients - Current patterns of misuse with an emphasis on the antianaerobic spectrum of activity
Unnecessary use of antimicrobials in hospitalized patients - Current patterns of misuse with an emphasis on the antianaerobic spectrum of activity
复制标题
DOI：
10.1001/archinte.163.8.972
复制
发表时间：
2003-04-28
影响因子：
--
通讯作者：
Donskey, CJ
中科院分区：
文献类型：
--
作者：
Hecker, MT;Aron, DC;Donskey, CJ
背景资料：不必要的使用抗菌药物有助于抗菌药物耐药的医院内病原体的出现和传播的一部分，通过消除正常的厌氧细菌植物群，抑制过度生长的病原微生物。方法：一项前瞻性观察研究进行了650张病床，大学附属医院。所有在2周内开具新抗菌药物处方的成人非重症监护住院患者在整个住院期间进行监测。我们检查了抗菌剂，特别是具有抗厌氧活性的抗菌剂，不必要地使用的频率。不必要的治疗的原因进行了评估，不必要的使用的共同模式identified.Results;共1941抗菌治疗日为129例患者。在1，941天的治疗中，共有576天（30%）被认为是不必要的。不必要治疗的最常见原因包括抗菌药物给药时间超过推荐持续时间（治疗192天），非感染性或非细菌性I型综合征的抗菌药物给药（治疗187天），以及定植或污染微生物的治疗（治疗94天）。在576个不必要的抗菌治疗日中，抗厌氧菌药物占203个（35%），这些药物也经常被处方（98天的治疗）时，同样有效的替代方案与最小的抗厌氧活性。结论：在我们的机构，住院患者经常接受不必要的抗菌治疗，当没有显示出这种活性谱时，通常会开抗厌氧药物。
Background: Unnecessary use of antimicrobials contributes to the emergence and dissemination of antimicrobial-resistant nosocomial pathogens in part through elimination of normal anaerobic bacterial flora that inhibit overgrowth of pathogenic microorganisms.Methods: A prospective observational study was conducted in a 650-bed, university-affiliated hospital. All adult nonintensive care inpatients for whom new antimicrobials were prescribed during a 2-week period were monitored throughout their hospitalization. We examined how often antimicrobials, in particular those with antianaerobic activity, were used unnecessarily. The reasons for unnecessary therapy were assessed and common patterns of unnecessary use were identified.Results; A total of 1941 antimicrobial days of therapy were prescribed for 129 patients. A total of 576 (30%) of the 1,941 days of therapy were deemed unnecessary. The most common reasons for unnecessary therapy included administration of antimicrobials for longer than recommended durations (192 days of therapy), administration of antimicrobials for noninfectious or nonbacterial I syndromes (187 days of therapy), and treatment of colonizing or contaminating microorganisms (94 days of therapy). Antianaerobic agents accounted for 203 (35%) of the 576 unnecessary antimicrobial days of therapy, and these agents were also frequently prescribed (98 days of therapy) when equally efficacious alternative regimens with minimal antianaerobic activity were available.Conclusions: In our institution, hospitalized patients frequently received unnecessary antimicrobial therapy, and antianaerobic agents were often prescribed when this spectrum of activity was not indicated.