Impact of an Antimicrobial Stewardship Intervention on Shortening the Duration of Therapy for Community-Acquired Pneumonia
Impact of an Antimicrobial Stewardship Intervention on Shortening the Duration of Therapy for Community-Acquired Pneumonia
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DOI：
10.1093/cid/cis242
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发表时间：
2012-06-01
影响因子：
11.8
通讯作者：
Cosgrove, Sara E.
中科院分区：
文献类型：
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作者：
Avdic, Edina;Cushinotto, Lisa A.;Cosgrove, Sara E.
背景。十年来，社区获得性肺炎 (CAP) 的初始管理一直是医疗保险和医疗补助服务中心的一项绩效衡量标准。我们假设，针对 CAP 管理的干预措施可以评估性能指标（在获得额外微生物学数据后的治疗持续时间和抗菌药物选择）未涵盖的领域，从而进一步改善 CAP 管理。方法。我们进行了一项单中心前瞻性研究，以比较干预前（2008年1月1日至2008年3月31日）和干预后（2010年2月1日至2010年5月10日）对疑似CAP的成年住院患者的管理，干预包括教育和向团队提供有关抗生素选择和持续时间的前瞻性反馈。主要结局指标是两个时期抗生素治疗的持续时间。结果。干预前有62名患者，干预期有65名患者。抗生素治疗持续时间从中位数 10 天缩短至 7 天 (P < .001)，抗生素治疗天数减少了 148 天。两组的中位住院时间相似（4 天与 5 天）。干预期间发现致病病原体的频率较低（14% vs 34%）；然而，在干预期间，根据药敏结果更频繁地缩小或修改抗生素范围（67% vs 19%）。在干预期间 24 小时内接受重复治疗的患者较少（90% vs 55%）。结论。我们机构的 CAP 治疗持续时间过长，通过管理干预缩短了治疗时间。需要在其他机构进行验证性研究；应认真考虑评估和缩短 CAP 治疗持续时间的努力。
Background. Initial management of community-acquired pneumonia (CAP) has been a Centers for Medicare and Medicaid Services performance measure for a decade. We hypothesized that an intervention directed at management of CAP that assesses areas not covered by the performance measures-treatment duration and antimicrobial selection after additional microbiology data are available-would further improve CAP management.Methods. We performed a single-center, prospective study to compare management of adult inpatients with presumed CAP before (from 1 January 2008 through 31 March 2008) and after (from 1 February 2010 through 10 May 2010) an intervention consisting of education and prospective feedback to teams regarding antibiotic choice and duration. The primary outcome measure was duration of antibiotic therapy in the 2 periods.Results. There were 62 patients in the preintervention period and 65 patients in the intervention period. The duration of antibiotic therapy decreased from a median of 10 to 7 days (P < .001), with 148 fewer days of antibiotic therapy. The median lengths of stay were similar in the 2 groups (4 vs 5 days). A causative pathogen was identified less frequently during the intervention period (14% vs 34%); however, antibiotics were more frequently narrowed or modified on the basis of susceptibility results during the intervention period (67% vs 19%). Fewer patients received duplicate therapy within 24 hours in the intervention period (90% vs 55%).Conclusions. The duration of therapy for CAP was excessive at our institution and was decreased with a stewardship intervention. Confirmatory studies at other institutions are needed; efforts to assess and reduce duration of therapy for CAP should be strongly considered.