STUDY OF ANTI-MICROBIAL MISUSE IN A UNIVERSITY HOSPITAL
STUDY OF ANTI-MICROBIAL MISUSE IN A UNIVERSITY HOSPITAL
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DOI：
10.1097/00000441-197805000-00005
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发表时间：
1978-01-01
影响因子：
3.1
通讯作者：
SCHUNA, AA
中科院分区：
文献类型：
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作者：
MAKI, DG;SCHUNA, AA
我们进行了一项前瞻性研究，以确定教学医院抗菌药物滥用的模式和后遗症以及与不适当抗菌药物治疗相关的因素。在8周的时间里，549名住院内科和外科患者中有144名（26.2%）接受了一个或多个疗程的抗菌药物治疗。每个疗程平均使用1.4种药物。假定感染是70%疗程和预防的原因，30%。总的来说，治疗在59%的疗程中被认为是合适的。不必要的治疗，糟糕的药物选择（细菌学，药理学，或两者兼而有之），或错误的预防是最常见的不适当治疗的基础。不良反应（总体为17%）发生率为两倍，治疗费用在不适当的疗程中高出55%。治疗前培养的表现（p < 0.05），在假定的呼吸道感染中获得革兰氏染色痰涂片（p < 0.001），以及记录中已建立抗菌治疗的标记（p < 0.001）与适当的治疗密切相关。这项研究强调需要更有效的研究生教育方案，强调传染病和抗菌药理学的基本原则和预防指南。抗菌药物使用审查应在医院医学自我评价方案中占有重要地位。讨论了提高抗生素使用水平的其他措施。
We undertook a prospective study to determine patterns and sequelae of antimicrobial misuse and factors associated with inappropriate antimicrobial therapy in a teaching hospital. Over an eight-week period, 144 (26.2%) of 549 hospitalized medical and surgical patients received one or more courses of antimicrobial therapy. An average course comprised 1.4 drugs. Presumptive infection was the reason for 70% of courses and prophylaxis, 30%. Therapy was judged appropriate in 59% of courses overall. Unnecessary therapy, poor drug choice (bacteriologically, pharmacologically, or both), or misguided prophylaxis most frequently underlay inappropriate therapy. Adverse reactions (17% overall) were twice as frequent and the cost of therapy was 55% greater in inappropriate courses. Performance of pretherapy cultures (p less than 0.05), obtaining gram-stained smears of sputum in presumed respiratory tract infections (p 0.001), and notation in the record that antimicrobial therapy had been instituted (p less than 0.001) were strongly associated with appropriate therapy. This study underscores the need for more effective programs of postgraduate education which stress basic principals of infectious disease and antimicrobial pharmacology and guidelines for prophylaxis. Antimicrobial utilization review should figure heavily in hospital programs of medical self-evaluation. Additional measures to upgrade the use of antibiotics are discussed.