De-escalation and discontinuation strategies in high-risk neutropenic patients: an interrupted time series analyses of antimicrobial consumption and impact on outcome
De-escalation and discontinuation strategies in high-risk neutropenic patients: an interrupted time series analyses of antimicrobial consumption and impact on outcome
复制标题
DOI：
10.1007/s10096-018-3328-1
复制
发表时间：
2018-10-01
影响因子：
4.5
通讯作者：
Cordonnier, Catherine
中科院分区：
文献类型：
--
作者：
la Martire, Giulia;Robin, Christine;Cordonnier, Catherine
发热性中性粒细胞减少症（FN）是血液科病房抗生素处方的主要原因，另一方面，抗生素管理（AS）探索不足。本研究的目的是评价（1）AS干预对抗生素消耗的影响和（2）干预的适用性和接受率及其临床影响。一个有说服力的AS干预的基础上，欧洲白血病感染会议（ECIL）的FN指南实施了一个高风险的血液病房在三级转诊公立大学医院。这包括制定和传播关于FN抗生素降级和停用的流程图，并在团队中引入一名医生，专门负责流程图的执行和抗生素处方的修订。纳入了住院期间接受抗生素治疗的所有连续患者。采用分段线性回归模型评估抗生素消耗量，考虑1年干预前和6个月干预期。总体而言，重新评价了137个连续的抗生素处方，其中100个处方用于FN。在干预期间，观察到碳青霉烯消耗水平显著降低（水平变化（估计系数+/-标准误）= -135. 28 +/-59. 49; p = 0. 04）。流程图的适用性和可接受性较高。在重症监护室转移、菌血症发生率和死亡率方面无差异，在血液学方面有说服力的AS干预显著降低了碳青霉烯类药物的消耗，而不影响结局，并被广泛接受。这应鼓励进一步应用欧洲委员会关于新生力量的准则。
Febrile neutropenia (FN) is the main reason for antibiotic prescription in hematology wards where, on the other hand, antibiotic stewardship (AS) is poorly explored. The objectives of the present study were to evaluate (1) the impact of an AS intervention on antibiotic consumption and (2) the applicability and acceptance rate of the intervention and its clinical impact. A persuasive AS intervention based on European Conference on Infection in Leukaemia (ECIL) guidelines for FN was implemented in a high-risk hematology ward in a tertiary referral public university hospital. This included the creation and diffusion of flow charts on de-escalation and discontinuation of antibiotics for FN, and the introduction in the team of a doctor dedicated to the implementation of flow charts and to antibiotic prescription revision. All consecutive patients receiving antibiotics during hospitalization were included. A segmented linear regression model was performed for the evaluation of antibiotic consumption, taking into account 1-year pre-intervention period and 6-month intervention period. Overall, 137 consecutive antibiotic prescriptions were re-evaluated, 100 prescriptions were for FN. A significant reduction of the level of carbapenem consumption was observed during the intervention period (level change (estimate coefficient +/- standard error) = - 135.28 +/- 59.49; p = 0.04). Applicability and acceptability of flow charts were high. No differences in terms of intensive care unit transfers, bacteremia incidence, and mortality were found. A persuasive AS intervention in hematology significantly reduced carbapenem consumption without affecting outcome and was well accepted. This should encourage further applications of ECIL guidelines for FN.