Impact of an Antimicrobial Stewardship Program Comprehensive Care Bundle on Management of Candidemia
Impact of an Antimicrobial Stewardship Program Comprehensive Care Bundle on Management of Candidemia
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DOI：
10.1002/phar.1186
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发表时间：
2013-02-01
期刊：
影响因子：
4.1
通讯作者：
Nagel, Jerod L.
中科院分区：
文献类型：
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作者：
Antworth, Allen;Collins, Curtis D.;Nagel, Jerod L.
研究目的分析由抗菌药物管理团队（AST）指导的综合护理包对念珠菌血症管理的影响。设计：单中心、准实验研究。一所拥有930张床位的学术医院。78例念珠菌血症患者接受了评估; 41例患者接受了念珠菌血症护理包（AST组），37例未接受（历史对照组）。测量和主要结果念珠菌血症护理包是由一个跨学科的AST开发的，结合了美国传染病学会的念珠菌血症管理临床实践指南的关键要素。AST根据护理包提出了前瞻性建议。集束元素是使用适当的抗真菌药物和适当的使用时间，移除静脉导管，重复血培养，监测念珠菌血症清除的时间，以及进行眼科检查。AST组对所有念珠菌血症护理包要素的依从性明显高于对照组（78.0% vs 40.5%，p=0.0016）。实施护理包显著提高了眼科检查率（97.6% vs 75.7%，p=0.0108）、选择适当的抗真菌治疗率（100% vs 86.5%，p=0.0488）和对适当治疗持续时间的依从性（97.6% vs 67.7%，p=0.0012）。此外，AST组超过推荐持续时间的治疗总天数少于对照组（5 vs 83总抗真菌天数）。AST组与对照组的住院时间（20 vs 21天，p=0.9184）、直至清除念珠菌血症的时间（3 vs 3天，p=0.610）、持续性念珠菌血症发生率（22% vs 40.5%，p=0.126）和复发性念珠菌血症发生率（4.9% vs 5.4%，p=0.916）相似。结论由本机构AST指导的全面念珠菌血症护理包改善了念珠菌血症患者的管理。我们鼓励进一步探索AST使用护理包作为其多方面方法的一部分，以促进适当的抗菌药物使用和优化感染性疾病患者的管理。
Study Objective To analyze the impact of a comprehensive care bundle directed by an antimicrobial stewardship team (AST) on the management of candidemia. Design Single-center, quasi-experimental study. Setting A 930-bed academic hospital. Patients Seventy-eight patients with candidemia were evaluated; 41 patients received the candidemia care bundle (AST group), and 37 did not (historical control group). Measurements and Main Results A candidemia care bundle was developed by an interdisciplinary AST, incorporating key elements from the Infectious Diseases Society of America's Clinical Practice Guidelines for the Management of Candidemia. The AST made prospective recommendations in accordance with the care bundle. Bundle elements were utilization of appropriate antifungal agents with appropriate duration of use, removal of intravenous catheters, repeat blood cultures, monitoring of time until clearance of candidemia, and performance of ophthalmologic examinations. Compliance with all candidemia care bundle elements was significantly higher in the AST group versus the control group (78.0% vs 40.5%, p=0.0016). Implementation of the care bundle significantly improved rates of ophthalmologic examination (97.6% vs 75.7%, p=0.0108), selection of appropriate antifungal therapy (100% vs 86.5%, p=0.0488), and compliance with an appropriate duration of therapy (97.6% vs 67.7%, p=0.0012). In addition, the AST group had fewer excess total days of therapy beyond the recommended duration than the control group (5 vs 83 total antifungal days). Length of hospitalization (20 vs 21days, p=0.9184), time until clearance of candidemia (3 vs 3days p=0.610), rate of persistent candidemia (22% vs 40.5%, p=0.126), and rate of recurrent candidemia (4.9% vs 5.4%, p=0.916) were similar in the AST group versus the control group. Conclusion A comprehensive candidemia care bundle directed by our institution's AST improved the management of patients with candidemia. We encourage further exploration into the use of care bundles by ASTs as part of their multifaceted approach to promoting appropriate antimicrobial utilization and optimizing the management of patients with infectious diseases.