Optimizing antimicrobial use in nursing homes: no longer optional.
Optimizing antimicrobial use in nursing homes: no longer optional.
复制标题
优化疗养院抗菌药物的使用：不再是可选的。
DOI：
10.1111/j.1532-5415.2007.01253.x
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发表时间：
2007
影响因子：
6.3
通讯作者：
Mody,Lona
中科院分区：
文献类型：
--
作者：
Mody,Lona
经验性和经常不适当的抗菌药物使用是广泛的，在所有的设置，但特别是在疗养院（NH）。1通常，抗生素的临床疗程在没有充分的临床评估的情况下开始。例如，NH居民中高达三分之一的疑似尿路感染处方是针对无症状的细菌尿患者。2抗生素的不当使用也是由于药物选择错误、抗生素的持续时间或剂量以及缺乏适当的实验室检测造成的。与其他全身性药物一样，不必要和不适当地使用抗生素会产生可怕的后果，如药物相互作用、药物不良事件、耐药性的发展以及过度的成本。1，3-5尽管需要适当的抗菌药物使用，但其在NH中的应用具有挑战性，主要是由于缺乏现场医生导致诊断延迟，缺乏老年人的临床发现，感染表现为全身性症状（如意识模糊和福尔斯）而不是感染特异性表现，以及缺乏现场诊断。1
Empirical and often inappropriate antimicrobial usage is extensive in all settings, but particularly in nursing homes (NHs). 1 Frequently, a clinical course of antibiotics is initiated without an adequate clinical evaluation. For example, up to one-third of prescriptions for suspected urinary tract infection in NH residents are for asymptomatic patients who are bacteriuric. 2 Inappropriate antibiotic usage also results from errors in drug choice, the duration or dosage of antibiotics, and the lack of appropriate laboratory testing.Unnecessary and inappropriate use of antimicrobials, like other systemic drugs, has dire consequences such as drug interactions, adverse drug events, development of antimicrobial resistance, and excess costs. 1, 3-5 Although appropriate antimicrobial usage is desired, its application in NHs is challenging, predominantly as a consequence of delay in diagnosis due to the absence of on-site physicians, lack of clinical findings in older adults, presentation of infection with generalized systemic symptoms (such as confusion and falls) rather than infection-specific presentation, and lack of on-site diagnostics. 1