Antimicrobial Use in Dialysis Units

描述（由申请人提供）：慢性血液透析（CHD）人群正在迅速增长。由抗生素耐药菌（ARB）引起的感染率在该患者人群中最高。抗菌药物的使用是出现的主要危险因素 和ARB的传播。有一个量化的数据，抗菌药物的使用和不适当的处方模式的冠心病患者，一个优先人群的医疗保健研究和质量机构。尚未制定专门针对门诊透析单位这一人群的全面抗菌药物管理计划。我们在两个门诊透析单位开展了一项试点研究，以量化和描述抗菌药物的不适当处方。我们的初步数据表明，根据国家指南，27.5%的抗菌药物剂量是不适当的。第三/第四代头孢菌素，其次是万古霉素，是最常见的不适当处方的抗菌药物。不适当处方的三个关键类别是：a]不符合诊断感染的国家共识标准，B]缺乏抗菌治疗的降级，c]术后24小时继续进行血液透析通路相关手术的手术预防。在本提案中，我们将制定、实施并证明抗菌药物管理计划在减少门诊透析单位抗菌药物处方和不当处方方面的有效性。该方案将包括教育干预以及系统和社会/行为改变战略。后者将涉及实施积极偏离办法。在干预前12个月和干预后12个月期间，将采用间断时间序列设计，每月收集数据。本提案的具体目的是：目的1-证明抗菌管理计划在减少门诊血液透析单位抗菌药物使用方面的有效性。目的2-证明抗菌药物管理计划在减少门诊血液透析单位抗菌药物不当使用方面的有效性。目的3-证明该抗菌药物管理计划的成本效益。证明这一抗菌药物管理计划的有效性将为CHD人群提供尚未满足且期待已久的需求，并最终通过降低ARB和ARB感染的患病率来改善该患者人群的健康结果。

DESCRIPTION (provided by applicant): The population of chronic hemodialysis (CHD) is rapidly growing. Rates of infections caused by antimicrobial-resistant bacteria (ARB) are among the highest in this patient population. Antimicrobial use is the main risk factor for the emergence and spread of ARB. There is a paucity of data quantifying antimicrobial use and inappropriate prescribing patterns among CHD patients, a priority population for the Agency of Healthcare Research and Quality. Comprehensive antimicrobial stewardship programs, specifically targeting this population in out-patient dialysis units, have not been developed. We initiated a pilot study in two out-patient dialysis units to quantify and characterize inappropriate prescribin of antimicrobials. Our preliminary data demonstrated that 27.5% of antimicrobial doses were prescribed inappropriately, as per national guidelines. Third/fourth generation cephalosporins, followed by vancomycin, were the most common antimicrobials prescribed inappropriately. The three key categories of inappropriate prescribing were a] national consensus criteria for diagnosing an infection were not met, b] lack of de-escalation of antimicrobial therapy and c] surgical prophylaxis for hemodialysis access-related procedures were continued e24 hours post-procedure. In this proposal we will develop, implement and demonstrate the effectiveness of an antimicrobial stewardship program in reducing antimicrobial prescribing and inappropriate prescribing in out-patient dialysis units. This program will include an educational intervention and both system and social/behavioral change strategies. The latter will involve the implementation of the Positive Deviance approach. An interrupted time series design will be used with monthly data collection during the12-month pre-intervention period and the 12- month post-intervention period. The specific aims of this proposal are: Aim 1-To demonstrate the effectiveness of an antimicrobial stewardship program in reducing antimicrobial use in out-patient hemodialysis units. Aim 2- To demonstrate the effectiveness of an antimicrobial stewardship program in reducing inappropriate antimicrobial use in out-patient hemodialysis units. Aim 3- To demonstrate the cost-effectiveness of this antimicrobial stewardship program. Demonstrating the efficacy of this antimicrobial stewardship program will provide an unmet and long overdue need in the CHD population and will ultimately improve health outcomes in this patient population by reducing the prevalence of ARB and ARB infections.