Assessments of Opportunities to Improve Antibiotic Prescribing in an Emergency Department: A Period Prevalence Survey.
Assessments of Opportunities to Improve Antibiotic Prescribing in an Emergency Department: A Period Prevalence Survey.
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DOI：
10.1007/s40121-017-0175-9
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发表时间：
2017-12
影响因子：
5.4
通讯作者：
LaPlante KL
中科院分区：
文献类型：
--
作者：
Timbrook TT;Caffrey AR;Ovalle A;Beganovic M;Curioso W;Gaitanis M;LaPlante KL
大约30%的门诊抗菌剂处方不当。目前，抗菌素处方模式在急诊科（ED）没有很好地描述。需要确定不适当的抗菌药物处方模式和通过抗菌药物管理规划（ASP）进行干预的机会。对2015年1月1日至12月31日在急诊科接受抗菌药物处方的非住院成年患者随机抽样进行回顾性图表回顾。适当性使用药物适当性指数进行测量，并基于提供者对当地指南的遵守。收集的其他信息包括患者特征、初始诊断和其他慢性药物使用情况。在2015年1579张ED类抗生素处方中，我们共审查处方记录159张（占10.1%）。最常用的抗菌药物包括青霉素类（22.6%）、大环内酯类（20.8%）、头孢菌素类（17.6%）和氟喹诺酮类（17.0%）。最常见的抗生素适应症是支气管炎或上呼吸道感染（URTI）（35.1%），其次是皮肤和软组织感染（SSTI）（25.0%），这两者都是导致不必要处方的最常见原因（支气管炎/URTIs占28.9%，SSTI占25.6%）。在审查的抗菌药物处方中，39%符合不适当标准。在78张对合适适应症达成共识的处方中，13.8%的处方存在剂量、疗程或费用不合适的情况。与全国门诊处方一致，急诊科不适当抗生素处方发生率为39%，其中支气管炎、尿路感染和SSTI患者的比例最高。抗菌药物管理项目可以通过关注ED患者的这些情况而受益。此外，针对这些和其他情况创建当地指南钱包可能有助于改善处方实践，并满足疾病控制和预防中心推荐的门诊管理核心要素。
Approximately 30% of all outpatient antimicrobials are inappropriately prescribed. Currently, antimicrobial prescribing patterns in emergency departments (ED) are not well described. Determining inappropriate antimicrobial prescribing patterns and opportunities for interventions by antimicrobial stewardship programs (ASP) are needed. A retrospective chart review was performed among a random sample of non-admitted, adult patients who received an antimicrobial prescription in the ED from January 1 to December 31, 2015. Appropriateness was measured using the Medication Appropriateness Index, and was based on provider adherence to local guidelines. Additional information collected included patient characteristics, initial diagnoses, and other chronic medication use. Of 1579 ED antibiotic prescriptions in 2015, we reviewed a total of 159 (10.1%) prescription records. The most frequently prescribed antimicrobial classes included penicillins (22.6%), macrolides (20.8%), cephalosporins (17.6%), and fluoroquinolones (17.0%). The most common indications for antibiotics were bronchitis or upper respiratory tract infection (URTI) (35.1%), followed by skin and soft tissue infection (SSTI) (25.0%), both of which were the most common reason for unnecessary prescribing (28.9% of bronchitis/URTIs, 25.6% of SSTIs). Of the antimicrobial prescriptions reviewed, 39% met criteria for inappropriateness. Among 78 prescriptions with a consensus on appropriate indications, 13.8% had inappropriate dosing, duration, or expense. Consistent with national outpatient prescribing, inappropriate antibiotic prescribing in the ED occurred in 39% of cases with the highest rates observed among patients with bronchitis, URTI, and SSTI. Antimicrobial stewardship programs may benefit by focusing on initiatives for these conditions among ED patients. Moreover, creation of local guideline pocketbooks for these and other conditions may serve to improve prescribing practices and meet the Core Elements of Outpatient Stewardship recommended by the Centers for Disease Control and Prevention.
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影响因子：
6.2
作者：
Metlay, Joshua P.;Camargo, Carlos A.;Gonzales, Ralph
通讯作者：
Gonzales, Ralph
影响因子：
3.1
作者：
Pallin, Daniel J.;Camargo, Carlos A., Jr.;Schuur, Jeremiah D.
通讯作者：
Schuur, Jeremiah D.
影响因子：
5
作者：
Grenet, J.;Davido, B.;Dinh, A.
通讯作者：
Dinh, A.
DOI：
10.1016/s2213-2600(17)30120-0
发表时间：
2017-05
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Brendish NJ;Malachira AK;Armstrong L;Houghton R;Aitken S;Nyimbili E;Ewings S;Lillie PJ;Clark TW
通讯作者：
Clark TW
影响因子：
120.7
作者：
Fleming-Dutra, Katherine E.;Hersh, Adam L.;Hicks, Lauri A.
通讯作者：
Hicks, Lauri A.