Do Inpatient Antimicrobial Stewardship Programs Help Us in the Battle Against Antimicrobial Resistance?
Do Inpatient Antimicrobial Stewardship Programs Help Us in the Battle Against Antimicrobial Resistance?
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DOI：
10.1093/cid/ciaa1004
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发表时间：
2021-12-01
影响因子：
11.8
通讯作者：
Qian, Lei
中科院分区：
文献类型：
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作者：
Tartof, Sara Y.;Chen, Lie Hong;Qian, Lei
背景抗生素管理计划（ASP）已证明在降低成本方面取得了成功，但其在减少高知名度耐药微生物感染方面的有效性的质量证据有限。这项回顾性队列研究包括2008年1月1日至2016年12月31日期间在9家KPSC医院住院的所有Kaiser Permanente Southern加州（KPSC）成员，年龄≥ 18岁。我们使用广义线性混合效应模型测量了交错ASP实施对18种ASP靶向抗生素消费的影响。我们使用多变量广义线性混合效应模型来估计ASP对耐药微生物感染率的调整效应。分析调整了混杂因素的时间，集群效应，患者和医院水平的特点。我们纳入了765111例住院病例（ASP前288257例，ASP后476854例）。根据规定的每日剂量，我们发现ASP后抗生素使用总体减少6.1%（-7.5%至4.7%）;根据治疗天数，我们检测到抗生素总体使用减少4.3%（-5.4%至3.1%）。ASP后处方数量增加（1.04 [1.03-1.05]）。在校正分析中，我们检测到ASP后万古霉素耐药肠球菌感染总体增加（1.37 [1.10-1.69]）。我们没有检测到ASP后超广谱β-内酰胺酶、碳青霉烯类耐药肠杆菌和多重耐药铜绿假单胞菌感染率的变化。成功减少目标抗生素消费的ASP在实施后2至6年内可能不会看到耐药性微生物感染率的变化。不同微生物和抗生素的敏感性逆转可能有不同的时间尺度，并且可能发生补偿性处方的非预期后果。
Background. Antibiotic stewardship programs (ASPs) have demonstrated success at reducing costs, yet there is limited quality evidence of their effectiveness in reducing infections of high-profile drug-resistant organisms.Methods. This retrospective, cohort study included all Kaiser Permanente Southern California (KPSC) members aged >= 18 years hospitalized in 9 KPSC hospitals from 1 January 2008 to 31 December 2016. We measured the impact of staggered ASP implementation on consumption of 18 ASP-targeted antibiotics using generalized linear mixed-effects models. We used multivariable generalized linear mixed-effects models to estimate the adjusted effect of an ASP on rates of infection with drug-resistant organisms. Analyses were adjusted for confounding by time, cluster effects, and patient- and hospital-level characteristics.Results. We included 765 111 hospitalizations (288 257 pre-ASP, 476 854 post-ASP). By defined daily dose, we found a 6.1% (-7.5% to -4.7%) overall decrease antibiotic use post-ASP; by days of therapy, we detected a 4.3% (-5.4% to -3.1%) decrease in overall use of antibiotics. The number of prescriptions increased post-ASP (1.04 [1.03-1.05]). In adjusted analyses, we detected an overall increase in vancomycin-resistant enterococci infections post-ASP (1.37 [1.10-1.69]). We did not detect a change in the rates of extended-spectrum beta-lactamase, carbapenem-resistant Enterobacteriaceae, and multidrug-resistant Pseudomonas aeruginosa infections post-ASP.Conclusions. ASPs with successful reductions in consumption of targeted antibiotics may not see changes in infection rates with antibiotic-resistant organisms in the 2 to 6 years post-implementation. There are likely differing timescales for reversion to susceptibility across organisms and antibiotics, and unintended consequences from compensatory prescribing may occur.