Antimicrobial stewardship intervention for the clinical pathways improves antimicrobial prophylaxis in surgical or non-surgical invasive therapies
Antimicrobial stewardship intervention for the clinical pathways improves antimicrobial prophylaxis in surgical or non-surgical invasive therapies
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DOI：
10.1111/ijcp.13293
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发表时间：
2019-03-01
影响因子：
2.6
通讯作者：
Murakami, Nobuo
中科院分区：
文献类型：
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作者：
Fujibayashi, Ayasa;Niwa, Takashi;Murakami, Nobuo
背景：在提倡合理使用抗菌药物的基础上，缩短了手术和非手术侵入性治疗中使用抗菌药物的标准时间。在这里，我们进行了一项干预，以优化抗菌素预防，根据最新的指南修订所有相关的临床路径。方法我们在接受抗菌药物预防的患者中进行了一项单中心前瞻性队列研究，以评估修订抗菌药物预防临床路径后的结果。比较修订临床路径前后的抗生素用量和用药时间。结果171条临床路径中有35条被认为不适合使用抗菌药物，并进行了优化。修订后抗生素使用时间显著缩短(修订前：3[1-5]天与修订后：2[1-3]天，中位数[四分位数范围]，P<；0.001)。术后48h内停用抗生素或非手术侵入性治疗的比例显著高于翻修后(62.4%vs81.8%，P<；0.001)。翻修前后手术部位感染发生率分别为5.7%和4.3%，差异无统计学意义(P=0.177)。多因素COX比例分析显示，术后48h内停用抗生素或非手术侵入性治疗是影响预后的因素之一(风险比0.69，95%可信区间0.63~0.76，P<；0.001)。结论修订所有相关临床路径，在不增加SSIs发生率的前提下，减少抗生素用量，缩短用药周期，是一种非常有效的方法。
Background The standard duration of administration of antimicrobial prophylaxis in surgery and non-surgical invasive therapy was shortened according to the promotion of appropriate use. Here, we conducted an intervention to optimise antimicrobial prophylaxis by revising all relevant clinical pathways based on the most recent guidelines. Methods We conducted a single-centre, prospective cohort study in patients who received antimicrobial prophylaxis to evaluate outcomes following revision of the clinical pathways for antimicrobial prophylaxis. Antibiotic consumption and the duration of antibiotic administration were compared before and after revising the clinical pathways. Results Thirty-five of 171 clinical pathways were considered inappropriate for antimicrobial use and were optimised. After this revision, the duration of antibiotic administration was significantly shortened (before revision: 3 [1-5] days vs after revision: 2 [1-3] days, median [interquartile range], P < 0.001). The rate of discontinuation of antibiotics within 48 h after surgery or non-surgical invasive therapy was significantly higher after the revision (62.4% vs 81.8%, P < 0.001). In contrast, the incidence of surgical site infection (SSI) was not significantly different before and after the revision (5.7% vs 4.3%, P = 0.177). A multivariate Cox proportional analysis indicated that revision of the clinical pathways was one of the prognostic factors associated with the discontinuation of antibiotics within 48 h after surgery or non-surgical invasive therapy (hazard ratio, 0.69; 95% confidence interval, 0.63-0.76, P < 0.001). Conclusions Our findings suggest that revising all relevant clinical pathways was highly effective in reducing antibiotic consumption and shortening the antibiotic administration period without increasing the incidence of SSIs.