Impact of Hospitalist-Led Interdisciplinary Antimicrobial Stewardship Interventions at an Academic Medical Center
Impact of Hospitalist-Led Interdisciplinary Antimicrobial Stewardship Interventions at an Academic Medical Center
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DOI：
10.1016/j.jcjq.2018.09.002
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发表时间：
2019-03-01
影响因子：
2.3
通讯作者：
Simon, Matthew S.
中科院分区：
文献类型：
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作者：
Tang, Stephanie J.;Gupta, Renuka;Simon, Matthew S.
背景：医院中大约20%-50%的抗菌药物使用不适当。有限的数据存在一线供应商的参与对抗菌药物stewardship outcomes.Methods的影响：三个成人内科教学服务在城市学术医院进行了一个三臂的前后质量改进研究。2016年9月至12月的数据与2015年同期的历史数据进行了比较。干预组为（1）教育包（仅教育）;（2）教育包加抗菌药物管理查房，每周两次，由接受过传染病培训的临床药剂师进行（艾德+IDPharmDx 2）;以及（3）教育包加内科培训的临床药剂师嵌入到日常主治查房中结果：仅Ed组、艾德+IDPharmDx 2组和艾德+IMPharmDx 5组的抗生素总使用量分别减少了16.8%（p <0.001）、6.8%（p= 0.08）和33.0%（p < 0.001）。仅Ed组、Ed-FIDPharmaa组和艾德+IMPharmDx 5组的广谱抗生素使用分别减少了26.2%（p <0.001）、7.8%（p= 0.09）和32.4%（p < 0.001）。艾德+IMPharmDx 5组的住院抗生素治疗持续时间从4天缩短至3天（p = 0.01）。接受任何抗生素治疗的患者的住院时间在仅ED组从9天减少到7天（p < 0.001），在艾德+IMP Dx 5组从9天减少到6天（p < 0.001）。有没有显着的变化，在30天内再次入院到同一设施，转移到ICU，或在医院死亡率的任何team.Conclusion：多学科，一线供应商驱动的方法，抗菌药物管理可能有助于减少抗生素的使用和住院时间。
Background: Approximately 20%-50% of antimicrobial use in hospitals is inappropriate. Limited data exist on the effect of frontline provider engagement on antimicrobial stewardship outcomes.Methods: A three-arm pre-post quality improvement study was conducted on three adult internal medicine teaching services at an urban academic hospital. Data from September through December 2016 were compared to historic data from corresponding months in 2015. Intervention arms were (1) Educational bundle (Ed-only); (2) Educational bundle plus antimicrobial stewardship rounds twice weekly with an infectious disease-trained clinical pharmacist (Ed+IDPharmDx2); and (3) Educational bundle plus internal medicine-trained clinical pharmacist embedded into daily attending rounds (Ed+IMPharmDx5).Results: Total antibiotic use decreased by 16.8% (p < 0.001), 6.8% (p= 0.08), and 33.0% (p < 0.001) on Ed-only, Ed+IDPharmDx2, and Ed+IMPharmDx5 teams, respectively. Broad-spectrum antibiotic use decreased by 26.2% (p < 0.001), 7.8% (p= 0.09), and 32.4% (p < 0.001) on the Ed-only, Ed-FIDPharmaa, and Ed+IMPharmDx5 teams, respectively. Duration of inpatient antibiotic therapy decreased from 4 to 3 days on the Ed+IMPharmDx5 team (p = 0.01). Length of stay for patients who received any antibiotic decreased from 9 to 7 days on the Ed-only team (p < 0.001) and from 9 to 6 days on the Ed+IMPharmDx5 team (p < 0.001). There was no significant change in 30-day readmission to the same facility, transfer to ICU, or in-hospital mortality for any team.Conclusion: Multidisciplinary, frontline provider-driven approaches to antimicrobial stewardship may contribute to reduced antibiotic use and length of hospital stay.