A Multidisciplinary Intervention to Reduce Infections of ESBL-and AmpC-Producing, Gram-Negative Bacteria at a University Hospital
A Multidisciplinary Intervention to Reduce Infections of ESBL-and AmpC-Producing, Gram-Negative Bacteria at a University Hospital
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DOI：
10.1371/journal.pone.0086457
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发表时间：
2014-01-23
期刊：
影响因子：
3.7
通讯作者：
Andersen, Stig Ejdrup
中科院分区：
文献类型：
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作者：
Knudsen, Jenny Dahl;Andersen, Stig Ejdrup
针对2008年产生ESBL/ ampc的克雷伯菌肺炎引起的感染大幅增加的情况，在一所大学医院开展了多学科干预，主要侧重于抗菌剂管理。另外四家医院作为对照。在整个干预医院传播了严格的抗菌素治疗和预防指南；头孢菌素仅限用于预防，氟喹诺酮类仅限用于感染性休克，碳青霉烯类除了用于严重败血症/感染性休克外，还用于青霉素过敏患者、ESBL/ ampc产生感染和其他耐药细菌。哌拉西林-他唑巴坦+/-庆大霉素被推荐用于大多数发热条件的经经验治疗。干预措施还包括关于感染控制的教育和指导，以及各种其他监测。以其他医院为对照，采用前后分析和中断时间序列分段回归分析，对选定细菌感染患者的发病率、结局和抗生素使用情况进行了为期两年的随访数据评估。干预措施导致抗菌药物用量持续变化，产生esbl的肺炎克雷伯菌感染的患者发生率显著下降(p
In response to a considerable increase in the infections caused by ESBL/AmpC-producing Klebsiella pneumonia in 2008, a multidisciplinary intervention, with a main focus on antimicrobial stewardship, was carried out at one university hospital. Four other hospitals were used as controls. Stringent guidelines for antimicrobial treatment and prophylaxis were disseminated throughout the intervention hospital; cephalosporins were restricted for prophylaxis use only, fluoroquinolones for empiric use in septic shock only, and carbapenems were selected for penicillin-allergic patients, infections due to ESBL/AmpC-producing and other resistant bacteria, in addition to their use in severe sepsis/septic shock. Piperacillin-tazobactam +/- gentamicin was recommended for empiric treatments of most febrile conditions. The intervention also included education and guidance on infection control, as well as various other surveillances. Two year follow-up data on the incidence rates of patients with selected bacterial infections, outcomes, and antibiotic consumption were assessed, employing before-and-after analysis and segmented regression analysis of interrupted time series, using the other hospitals as controls. The intervention led to a sustained change in antimicrobial consumption, and the incidence of patients infected with ESBL-producing K. pneumoniae decreased significantly (p