Efficacy of educational intervention on reducing the inappropriate use of oral third-generation cephalosporins
Efficacy of educational intervention on reducing the inappropriate use of oral third-generation cephalosporins
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DOI：
10.1007/s15010-019-01362-x
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发表时间：
2019-10-11
期刊：
影响因子：
7.5
通讯作者：
Miyara, Takayuki
中科院分区：
文献类型：
--
作者：
Uda, Atsushi;Kimura, Takeshi;Miyara, Takayuki
目的本研究旨在评价教育干预在减少口服第三代头孢菌素的不当使用、耐药细菌的流行和临床结果方面的效果。方法对日本某大学医院干预前后1年的数据进行比较。教育干预包括对所有医务人员进行口服抗生素的讲座，并与每个医疗部门举行教育会议。主要结果是在住院患者中使用口服第三代头孢菌素，以每月每1000患者日中位治疗天数(DOTS)衡量。次要结果包括住院患者和门诊患者使用每种口服抗生素的情况、不产生β-内酰胺酶的耐氨苄西林流感嗜血杆菌(BLNAR)、耐青霉素的肺炎链球菌(PRSP)和产超广谱β-内酰胺酶的大肠埃希菌(ESBLEC)的比例、医院获得性艰难梭菌感染(HA-CDI)的发生率和住院死亡率。结果干预后住院患者口服第三代头孢菌素的使用量显著减少[DOTS(四分位数范围)：24.2(23.5~25.1vs.3.7，P<；0.001)]。干预后氟喹诺酮类药物和大环内酯类药物的使用量没有增加。在研究期间，BLNAR、PRSP和ESBLEC的比例没有显著变化。干预后HA-CDI发生率明显降低，住院病死率无明显变化。结论教育干预能有效减少口服第三代头孢菌素的使用，且不增加广谱抗生素的使用，不影响临床疗效。在研究期间，耐药细菌的流行率没有变化。
Purpose This study aimed to evaluate the efficacy of an educational intervention on reducing the inappropriate use of oral third-generation cephalosporins, the prevalence of resistant bacteria, and clinical outcomes. Methods A before-after study was conducted to compare the data for 1 year before and after intervention at a Japanese university hospital. Educational intervention included lectures for all medical staff on oral antibiotics and educational meetings with each medical department. The primary outcome was the use of oral third-generation cephalosporins in inpatients as measured by the monthly median days of therapy (DOTs) per 1000 patient days. Secondary outcomes included the use of each oral antibiotic in inpatients and outpatients, proportion of beta-lactamase-nonproducing ampicillin-resistant Haemophilus influenzae (BLNAR), penicillin-resistant Streptococcus pneumoniae (PRSP) and extended-spectrum beta-lactamase producing Escherichia coli (ESBLEC), the incidence of hospital-acquired Clostridioides difficile infection (HA-CDI), and hospital mortality. Results The use of oral third-generation cephalosporins in inpatients was significantly decreased after intervention [DOTs (interquartile range): 24.2 (23.5-25.1) vs. 3.7 (0.0-7.1), P < 0.001], and the value in outpatients was also decreased significantly. The use of fluoroquinolones and macrolides did not increase after intervention. The proportion of BLNAR, PRSP and ESBLEC did not change significantly during the study period. The incidence of HA-CDI was significantly decreased, and hospital mortality did not change after intervention. Conclusion Educational intervention was effective in reducing the use of oral third-generation cephalosporins without increasing the use of broad-spectrum antibiotics and worsening clinical outcome. The prevalence of resistant bacteria did not change during the study period.