Impact of an antimicrobial utilization program on antimicrobial use at a large teaching hospital: a randomized controlled trial.
Impact of an antimicrobial utilization program on antimicrobial use at a large teaching hospital: a randomized controlled trial.
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DOI：
10.1086/605924
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发表时间：
2009-10
影响因子：
4.5
通讯作者：
Blumberg HM
中科院分区：
文献类型：
--
作者：
Camins BC;King MD;Wells JB;Googe HL;Patel M;Kourbatova EV;Blumberg HM
多学科抗菌药物利用团队（AUT）已被提议作为改善抗菌药物使用的机制，但有关其功效的数据仍然有限。确定AUT对教学医院抗菌药物使用的影响。随机对照干预试验。拥有953张床位的公立大学附属城市教学医院。由内科病房团队处方选定抗菌药物（哌拉西林-他唑巴坦、左氧氟沙星或万古霉素）的患者。每月随机分配12个内科团队：6个团队进入干预组（由AUT进行学术详细说明），6个团队进入对照组，在10个月的研究期间提供基于适应症的广谱抗菌药物处方指南（标准治疗）。适当的经验性、确定性（治疗性）和最终抗菌剂（总体）使用比例。共审查了哌拉西林-他唑巴坦、左氧氟沙星和万古霉素的784张新处方。干预小组开具的适当抗菌药物处方比例明显高于对照组：82% vs. 73%经验性（RR=1.14，95% CI 1.04-1.24），82% vs. 43%，明确（RR=1.89，95% CI 1.53-2.33），以及94% vs. 70%（RR=1.34，95% CI 1.25-1.43）。在多变量分析中，与对照组相比，仅从AUT（aRR=1.37，95% CI 1.27-1.48）或从AUT和ID咨询服务（aRR=2.28，95% CI 1.64-3.19）获得反馈的团队更有可能适当地处方最终抗菌药物使用。多学科AUT为处方医生提供反馈是改善抗菌药物使用的有效方法。
Multidisciplinary antimicrobial utilization teams (AUT) have been proposed as a mechanism for improving antimicrobial use, but data on their efficacy remain limited. To determine the impact of an AUT on antimicrobial use at a teaching hospital. Randomized controlled intervention trial. A 953-bed public university-affiliated urban teaching hospital. Patients who were prescribed selected antimicrobial agents (piperacillin-tazobactam, levofloxacin, or vancomycin) by internal medicine ward teams. Twelve internal medicine teams were randomized monthly: 6 teams to intervention group (academic detailing by the AUT), and 6 teams to a control group given indication-based guidelines for prescription of broad spectrum antimicrobials (standard of care) during a 10-month study period. Proportion of appropriate empiric, definitive (therapeutic), and end antimicrobial (overall) usage. A total of 784 new prescriptions of piperacillin-tazobactam, levofloxacin, and vancomycin were reviewed. The proportion of appropriate antimicrobial prescriptions written by the intervention teams was significantly higher than prescribed by the control teams: 82% vs. 73% for empiric (RR=1.14, 95% CI 1.04–1.24), 82% vs. 43% for definitive (RR=1.89, 95% CI 1.53–2.33), and 94% vs. 70% for end antimicrobial usage (RR=1.34, 95% CI 1.25–1.43). In a multivariate analysis, teams that received feedback from the AUT alone (aRR=1.37, 95% CI 1.27–1.48) or from both the AUT and the ID consult service (aRR=2.28, 95% CI 1.64–3.19) were significantly more likely to prescribe end antimicrobial usage appropriately compared to control teams. A multidisciplinary AUT which provides feedback to prescribing physicians was an effective method in improving antimicrobial use.
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影响因子：
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作者：
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通讯作者：
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