Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a LID on antibiotic use.
Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a LID on antibiotic use.
复制标题
DOI：
10.1086/668429
复制
发表时间：
2012-12
影响因子：
4.5
通讯作者：
Donskey CJ
中科院分区：
文献类型：
--
作者：
Jump RL;Olds DM;Seifi N;Kypriotakis G;Jury LA;Peron EP;Hirsch AA;Drawz PE;Watts B;Bonomo RA;Donskey CJ
我们推出了长期护理机构 (LTCF) 传染病 (ID) 咨询服务 (LID)，为 VA LTCF 的居民提供现场咨询。我们确定了 LID 服务对 LTCF 抗菌药物使用和艰难梭菌感染的影响。拥有 160 个床位的退伍军人事务部 (VA) LTCF。使用中断时间序列的分段回归分析，比较了 LTCF 开始 ID 咨询服务之前 36 个月和之后 18 个月的全身抗菌药物使用和艰难梭菌检测阳性率。与干预前相比，全身抗生素给药总量减少了 30% (P <.001)，口服药物 (32%；P<.001) 和静脉注射药物 (25%；P =.008) 均显着减少。降幅最大的是四环素类药物（64%，P <.001）、克林霉素（61%；P <.001）、磺胺甲恶唑/甲氧苄啶（38%；P <.001）、氟喹诺酮类药物（38%；P <.001）和 β-内酰胺/β-内酰胺酶抑制剂组合（28%；P <.001）。与干预前相比，LTCF 中艰难梭菌阳性检测的变化率在干预后有所下降 (P = 0.04)。 LTCF ID 服务的实施导致抗菌药物使用总量显着减少。将具有传染病专业知识的提供者引入 LTCF 是实现抗菌药物管理的一种新的有效方法。
We introduced a long-term care facility (LTCF) Infectious Disease (ID) consult service (LID) that provides on-site consultations to residents of a VA LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF. A 160-bed Veterans Affairs (VA) LTCF. Systemic antimicrobial use and the rate of positive C. difficile tests at the LTCF were compared for 36 months before and 18 months after the initiation of the ID consultation service using segmented regression analysis of an interrupted time-series. In contrast to the pre-intervention period, total systemic antibiotic administration decreased by 30% (P <.001) with a significant reduction in both oral (32%; P<.001) and intravenous agents (25%; P =.008). The greatest reductions were seen for tetracyclines (64%, P <.001), clindamycin (61%; P <.001), sulfamethoxazole/trimethoprim (38%; P <.001), fluoroquinolones (38%; P <.001) and beta-lactam/beta-lactamase inhibitor combinations (28%; P <.001). Rates of change for positive C. difficile tests at the LTCF declined in the post- vs. preintervention periods (P = .04). Implementation of a LTCF ID service led to a significant reduction in total antimicrobial use. Bringing providers with infectious disease expertise to the LTCF represents a new and effective means to achieve antimicrobial stewardship.
登录
查看更多内容
影响因子：
4.5
作者：
Nicolle, LE;Bentley, DW;Smith, PW
通讯作者：
Smith, PW
DOI：
10.1111/j.1532-5415.2007.01251.x
发表时间：
2007-08-01
影响因子：
6.3
作者：
Schwartz, David N.;Abiad, Homer;Weinstein, Robert A.
通讯作者：
Weinstein, Robert A.
DOI：
10.1046/j.1365-2710.2002.00430.x
发表时间：
2002-08-01
影响因子：
2
作者：
Wagner, AK;Soumerai, SB;Ross-Degnan, D
通讯作者：
Ross-Degnan, D
影响因子：
11.8
作者：
Jump, Robin L. P.;Riggs, Michelle M.;Donskey, Curtis J.
通讯作者：
Donskey, Curtis J.
影响因子：
11.8
作者：
Riggs, Michelle M.;Sethi, Ajay K.;Donskey, Curtis J.
通讯作者：
Donskey, Curtis J.