感染対策チームによる抗ＭＲＳＡ薬の使用に対する介入効果の検討

检查感染控制小组对使用抗 MRSA 药物的干预效果

• 批准号: 26929022
• 负责人: 丹羽 隆
• 金额: $ 0.32万
• 依托单位: Gifu University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Encouragement of Scientists
• 财政年份: 2014
• 资助国家: 日本
• 起止时间: 2014-04-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-26929022/
• 关键词: 感染対策チーム; 抗MRSA薬; 介入

【目的】抗菌薬適正使用の推進は、ICTの重要な役割である。岐阜大学医学部附属病院(以下、当院)では、Antimicrobial Stewardshipガイドラインの「介入とフィードバック」に基づき、ICDと薬剤師が中心となって、注射用抗菌薬使用全患者を対象とした抗菌薬監視体制を2009年に構築した。今回は、本体制確立による抗MRSA薬使用症例における治療効果、副作用の発現を検討した。【方法】調査期間は、2008年8月から2009年7月を介入前、2011年8月から2012年7月を介入後とした。対象は調査期間中に抗MRSA薬を使用した症例とし、周術期使用症例および発熱性好中球減少症例は除外した。グラム陽性菌による感染関連死、抗MRSA薬終了後1か月以内の再発率、副作用発現率を介入前後で比較した。【結果】対象症例は介入前99名、介入後125名であった。介入後はほぼ全例で抗MRSA薬開始前からICTが薬剤選択、投与設計に関わり、開始前の時点で約60%の症例で腎機能、組織移行性、原因菌の感受性などの理由からICTが薬剤変更を提案した。介入後はCRPが投与前値の50%に低下するまでの日数(p=0.01)、37℃以下に解熱するまでの日数(p=0.07)が短縮し、グラム陽性菌による感染関連死も有意に減少した(22.2% vs 6.4%、p<0.001)。抗MRSA薬使用期間は介入前後で差を認めず、再発率は介入後に有意に低下した(16.8% vs 5.3%、p=0.009)。抗MRSA薬による副作用発現率は、介入前26.0%から介入後2.4%へと有意に減少した(p<0.001)。【考察】以上、ICTが抗MRSA薬投与開始時から薬剤選択、投与設計に関与することにより、抗MRSA薬の治療成績および安全性の向上に貢献できることが示唆された。

【Purpose】The promotion of appropriate use of antibacterial drugs and the importance of ICT are the key points. Gifu University School of Medicine Affiliated Hospital (hereinafter, the hospital)では, Antimicrobial Stewardshipとフィードバック」に记づき、ICDと薬艤师がThe center monitors and monitors the use of injectable antibacterial drugs for all patients, and the antibacterial drug monitoring system was established in 2009. This time, we have established the system to demonstrate the treatment effects and side effects of anti-MRSA anti-MRSA antibiotics. [Method] The investigation period was from August 2008 to July 2009 before the intervention, August 2011 to July 2012 after the intervention. During the investigation period, the cases of anti-MRSA antibiotics used during the investigation period were excluded, and the cases of peri-operative use were excluded. The results of the comparison of mortality related to infections caused by グラム-positive bacteria, the recurrence rate within 1 month after the completion of anti-MRSA treatment, and the occurrence rate of side effects were compared before and after intervention. [Results] There were 99 symptomatic cases before the intervention and 125 after the intervention. Post-intervention, complete case, anti-MRSA treatment, before the start of the treatment, ICT treatment selection, investment in design, and time point before the start. Approximately 60% of the cases are based on renal function, tissue migration, and susceptibility to the causative bacteria, and the reasons for this are the proposed changes in ICT. The number of days after the intervention that CRP was lowered by 50% before the intervention (p=0.01), and the number of antipyretic days below 37°C The number of days of infection (p=0.07) was shortened, and the number of deaths associated with infection with positive bacteria was reduced (22.2%). vs 6.4%, p<0.001). During the use of anti-MRSA medication, the difference between pre- and post-intervention was significantly lower, and the recurrence rate was significantly lower than after intervention (16.8% vs 5.3%, p=0.009). The occurrence rate of side effects of anti-MRSA treatment was 26.0% before intervention and 2.4% after intervention, and the incidence rate was significantly reduced (p<0.001). 【Investigation】The above, the selection of ICT at the beginning of anti-MRSA injection, and the details of investment and designとにより, anti-MRSA 薬のtreatment results and およびsafetyのcontribution to できることがshows instigation された.