Antibiotic combinations with redundant antimicrobial spectra: Clinical epidemiology and pilot intervention of computer-assisted surveillance
Antibiotic combinations with redundant antimicrobial spectra: Clinical epidemiology and pilot intervention of computer-assisted surveillance
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DOI：
10.1086/376623
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发表时间：
2003-07-01
影响因子：
11.8
通讯作者：
Weinstein, RA
中科院分区：
文献类型：
--
作者：
Glowacki, RC;Schwartz, DN;Weinstein, RA
多余的抗生素组合是抗生素过度使用的潜在可补救来源。在一家公立教学医院，我们确定了这种组合的发病率、成本和适应症，并测量了基于药剂师的干预措施的效果。在1189名接受大于或等于2种抗生素的住院患者中，计算机辅助筛选确定了192名患者（16.1%）接受了潜在的冗余组合。图表审查显示，137集（71%）是不合适的。在77次发作（56%）中发现了医生过度处方错误;大多数涉及对革兰氏阳性或厌氧微生物的冗余覆盖。在76起事件（55%）中，药物订购和分配系统的失误导致药房记录中持续存在根据患者图表不再有效的方案。与医疗服务相比，重症监护室和手术服务中多余抗生素组合的发生率显著较高。在137次发作中，134次（98%）成功停止多余药物的干预。潜在的药物成本节省和减少多余的抗生素组合天数分别为10，800美元和584天;药剂师对患者进行审查和干预的时间为2880美元。使用多余的抗生素组合是常见的，基于药剂师的干预是可行的，每年可能节省48，000美元的成本。
Redundant antibiotic combinations are a potentially remediable source of antibiotic overuse. At a public teaching hospital, we determined the incidence, cost, and indications for such combinations and measured the effects of a pharmacist-based intervention. Of 1189 inpatients receiving greater than or equal to2 antibiotics, computer-assisted screening identified 192 patients (16.1%) receiving potentially redundant combinations. Chart reviews showed that 137 episodes (71%) were inappropriate. Physician overprescribing errors were found in 77 episodes (56%); most involved redundant coverage for gram-positive or anaerobic organisms. In 76 episodes (55%), lapses in the medication ordering and distribution system led to the persistence in the pharmacy records of regimens no longer active according to the patient charts. The incidence of redundant antibiotic combinations was significantly higher in the intensive care unit and surgery services, compared with medical services. Interventions to discontinue redundant agents were successful in 134 (98%) of the 137 episodes. Potential drug cost savings and reduction in redundant antibiotic combination days were $10,800 and 584 days, respectively; pharmacist time for patient review and intervention cost $2880. Use of redundant antibiotic combinations was common, and a pharmacist-based intervention was feasible, with a potential annualized cost savings of $48,000.