2089. Effect of the Duke Antimicrobial Stewardship Outreach Network (DASON): A Multi-Center Time Series Analysis
2089. Effect of the Duke Antimicrobial Stewardship Outreach Network (DASON): A Multi-Center Time Series Analysis
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2089.杜克抗菌药物管理外展网络 (DASON) 的效果：多中心时间序列分析
DOI：
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发表时间：
2019
影响因子：
4.2
通讯作者：
R. Moehring
中科院分区：
文献类型：
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作者：
M. Yarrington;E. D. Dodds Ashley;Melissa D. Johnson;Angelina Davis;April P. Dyer;T. Jones;D. Sexton;D. Anderson;R. Moehring
摘要背景DASON是美国东南部一个由30名成员组成的社区医院网络，支持当地抗生素管理计划（ASP）的发展和增长。合作活动包括联络临床药剂师的现场访问，常规反馈和基准的数据共享以及教育计划。方法我们对2013-2018年期间参与DASON至少42个月的17家医院的抗生素使用（Au）进行了回顾性队列分析。使用分段负二项回归模型估计初始1年评估、计划和ASP干预启动期后机构范围内的Au变化。将基线Au趋势（1 - 12个月）与第1年（13 - 42个月）后的Au进行比较。每月Au率以每1,000患者日（pd）的治疗天数（DOT）为单位进行测量。模型评估了总体Au和特定抗生素组，如国家医疗保健安全网络Au选项所定义。该模型控制了医院规模、网络进入时预先存在的正式ASP以及网络进入年份。结果5年来医院数据共包括2，988，930例PD。设施范围内的Au在网络进入的第一年增加，然后开始每月下降0.2%（P = 0.01，图）。氟喹诺酮类药物的使用在第一年停滞，然后每月下降1.5%（P ≤ 0.001，图）。抗真菌药物在第一年减少，此后每月继续减少0.7%（P = 0.03，图）。主要用于耐药革兰氏阳性菌感染的药物和用于医院发作感染的广谱药物在第一年增加，然后减弱，尽管斜率变化没有达到统计学显著性。在任何模型中，预先存在的正式ASP的存在都不是一个显著的协变量，而床的大小和进入网络的年份对一些抗生素组的模型有显著的贡献。结论参与DASON与社区医院总Au和氟喹诺酮类药物使用的下降以及其他广谱药物使用的减少趋势有关。合作网络的经验可以帮助当地ASP实现减少Au。披露所有作者：没有报告披露。
Abstract Background DASON is a 30-member, community hospital network in the southeastern United States that supports the development and growth of local antibiotic stewardship programs (ASPs). Collaborative activities include on-site visits from liaison clinical pharmacists, data sharing for routine feedback and benchmarking, and educational programs. Methods We performed a retrospective cohort analysis of antibiotic use (AU) in 17 hospitals that participated in DASON for a minimum of 42 months during 2013–2018. Segmented negative binomial regression models were used to estimate the change in facility-wide AU after an initial 1-year assessment, planning, and ASP intervention initiation period. Baseline AU trend (1 to 12 months) was compared against AU following the first year (13 to 42 months). Monthly AU rates were measured in days of therapy (DOT) per 1,000 patient-days (pd). Models assessed overall AU and specific antibiotic groups, as defined by the National Healthcare Safety Network AU option. The models controlled for hospital size, presence of a pre-existing formal ASP upon network entry, and year of network entry. Results Hospital data included a total of 2,988,930 pd over 5 years. Facility-wide AU was increasing during the first year of network entry and then began decreasing by 0.2% per month (P = 0.01, figure). Fluoroquinolone use was stagnant in year one and then decreased by 1.5% per month (P ≤ 0.001, figure). Antifungal agents were decreasing in year one and continued to decrease 0.7% per month thereafter (P = 0.03, figure). Agents predominantly used for resistant Gram-positive infections and broad-spectrum agents used for hospital-onset infections were increasing during year one and then attenuated afterward, though the slope change did not reach statistical significance. The presence of a pre-existing formal ASP was not a significant covariate in any model, while bed size and year of network entry significantly contributed to models of some antibiotic groups. Conclusion Participation in DASON was associated with a decline in total AU and fluoroquinolone use, and a trend toward attenuated use of other broad-spectrum agents in community hospitals. Collaborative network experiences can help local ASPs achieve reductions in AU. Disclosures All authors: No reported disclosures.