Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial
Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial
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DOI：
10.1136/bmj.38602.586343.55
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发表时间：
2005-09-24
影响因子：
--
通讯作者：
Walter, SD
中科院分区：
文献类型：
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作者：
Loeb, M;Brazil, K;Walter, SD
目的评估多方面干预是否可以减少护理院居民疑似尿路感染的抗菌药物处方数量。设计随机对照试验。设置24个护理院在安大略，加拿大和爱达荷州，美国。参与者12个护理院分配到一个多方面的干预和12个分配到常规护理。结果被测量在4217 residents.Interventions泌尿道感染的诊断和治疗算法实施在疗养院水平使用多方面的方法-小组互动会议的护士，录像带，书面材料，外展访问，和一对一的采访与医生。结果干预护理院每1000个住院日的疑似尿路感染的抗菌药物疗程比普通护理院少（1.17 v1.59疗程;加权平均差异-0.49，95%置信区间-0.93 to -0.06）。疑似尿路感染的抗菌药物占干预护理院处方的所有疗程的28.4%，而普通护理院处方的抗菌药物占38.6%（加权平均差异为-9.6%，-16.9%至-2.4%）。干预组和常规护理组之间每1000住院日的抗菌药物总使用量差异无显著性差异（3.52 vs 3.93;加权平均差异-0.37，-1.17至0.44）。研究arms. Conclusion之间的入院率或死亡率没有显着差异，使用算法的多方面干预可以减少养老院居民疑似尿路感染的抗菌药物处方数量。
Objective To assess whether a multifaceted intervention can reduce the number of prescriptions for antimicrobials for suspected urinary tract infections in residents of nursing homes.Design Cluster randomised controlled trial.Setting 24 nursing homes in Ontario, Canada, and Idaho, United States.Participants 12 nursing homes allocated to a multifaceted intervention and 12 allocated to usual care. Outcomes were measured in 4217 residents.Interventions Diagnostic and treatment algorithm for urinary tract infections implemented at the nursing home level using a multifaceted approach-small group interactive sessions for nurses, videotapes, written material, outreach visits, and one on one interviews with physicians.Main outcome measures number of antimicrobials prescribed for suspected urinary tract infections, total use of antimicrobials, admissions to hospital, and deaths.Results Fewer courses of antimicrobials for suspected urinary tract infections per 1000 resident days were prescribed in the intervention nursing homes than in the usual care homes (1.17 v 1.59 courses; weighted mean difference -0.49, 95% confidence intervals -0.93 to -0.06). Antimicrobials for suspected urinary tract infection represented 28.4% of all courses of drugs prescribed in the intervention nursing homes compared with 38.6% prescribed in the usual care homes (weighted mean difference -9.6%, -16.9% to -2.4%). The difference in total antimicrobial use per 1000 resident days between intervention and usual care groups was not significantly different (3.52 v 3.93; weighed mean difference -0.37, -1.17 to 0.44). No significant difference was found in admissions to hospital or mortality between the study arms.Conclusion A multifaceted intervention using algorithms can reduce the number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes.