Clinical Impact of an Antibiotic Stewardship Program at a Children's Hospital.
Clinical Impact of an Antibiotic Stewardship Program at a Children's Hospital.
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DOI：
10.1007/s40121-016-0139-5
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发表时间：
2017-03
影响因子：
5.4
通讯作者：
Newland JG
中科院分区：
文献类型：
--
作者：
Lee BR;Goldman JL;Yu D;Myers AL;Stach LM;Hedican E;Jackson MA;Newland JG
抗生素管理计划 (ASP) 改善抗生素的合理使用。关于 ASP 在儿童医院中的临床益处的数据有限。本研究的目的是确定 ASP 对儿童医院收治患者的住院时间 (LOS) 和再入院率的影响。来自前瞻性审核和反馈 ASP 的数据用于检查 ASP 审查特征，包括处方抗生素、临床适应症、ASP 提出的建议以及与建议的一致性。根据患者是否收到 ASP 建议以及临床医生是否同意建议，利用倾向评分分析来确定 ASP 对 LOS 和 30 天再入院的影响。根据患者是否患有复杂的慢性病状态 (CCC) 及其服务范围（医疗或外科）进行分层。在纳入的 8038 项审查中，1362 项（16.9%）提出的建议在 1116 项（81%）案例中得到了同意。倾向评分分析表明，接受 ASP 建议的非 CCC 药物组的 LOS 明显更长（80.9 小时与 67.6 小时，p < 0.001）。然而，对于同意 ASP 建议的 CCC 医学患者，观察到临床相关的 LOS 下降（158.1 小时 vs. 180.3 小时，p = 0.095）。与未收到推荐的患者相比，接受推荐的 CCC 医学患者的 30 天再入院率显着更高（分别为 7.3% 和 4.2%；p = 0.005）。没有 CCC 且获得 ASP 推荐的儿童的住院时间更长。对于患有 CCC 的儿童，ASP 似乎可以减少 LOS 并显着降低 30 天的再入院率。总的来说，这项研究表明 ASP 提供了有意义的临床效益，证明了开发和维护 ASP 项目所需的资源分配是合理的。本文的在线版本 (doi:10.1007/s40121-016-0139-5) 包含补充材料，可供授权用户使用。
Antibiotic stewardship programs (ASP) improve appropriate antibiotic use. Data are limited on the clinical benefit of ASPs in children’s hospitals. This study’s objective was to determine the impact of an ASP on length of stay (LOS) and readmission rate among patients admitted to children’s hospitals. Data from a prospective-audit-with-feedback ASP were used to examine the ASP review characteristics, including antibiotic(s) prescribed, clinical indication, recommendations made by the ASP, and agreement with recommendations. Propensity score analysis was utilized to determine the impact of the ASP on LOS and 30-day readmission based on whether the patient received an ASP recommendation and if the clinician agreed with recommendations. Patients were stratified on if they had a complex chronic condition status (CCC) and their service line, medical or surgical. Of the 8038 reviews included, 1362 (16.9%) resulted in a recommendation that was agreed with in 1116 (81%) cases. Propensity score analysis demonstrated a significantly longer LOS for the non-CCC medicine group who received an ASP recommendation (80.9 vs. 67.6 h, p < 0.001). However, for CCC medicine patients that agreed with the ASP recommendation, a clinically relevant decrease in LOS (158.1 vs. 180.3 h, p = 0.095) was observed. The 30-day readmission rate was significantly greater in CCC medicine patients when comparing those who did not receive a recommendation versus those who did receive a recommendation (7.3% vs 4.2%, respectively; p = 0.005). Children without a CCC who received an ASP recommendation had a longer length of stay. For children with CCCs, the ASP appeared to decrease LOS and significantly reduce 30-day readmission rates. Overall, this study demonstrate that ASPs offer meaningful clinical benefit justifying resource allocation needed to develop and maintain ASP programs. The online version of this article (doi:10.1007/s40121-016-0139-5) contains supplementary material, which is available to authorized users.