Improving Antimicrobial Use

描述(由申请人提供)：本建议是综合职业发展计划的一部分，该计划包括临床研究方面的高级教学培训和以患者为导向的密集、有指导的研究经验，目的是发展在临床研究领域成功、独立职业所必需的技能和经验。候选人的目标是建立一个独立的、成功的研究计划，专注于抗菌素的使用和耐药性。 教学培训将作为研究职业发展计划的一部分进行，以扩大候选人通过硕士获得的临床研究的现有基础 临床研究科学(MSCR)学位。这一额外的教学培训提供了学习拟议临床研究中不可或缺的其他技术和方法组成部分的机会，包括结果研究、成本分析和行为流行病学。候选人的导师和内部咨询委员会是公认的传染病临床研究人员，他们致力于促进候选人的职业发展，并对候选人的进步和正在进行的研究进行批判性评估。在埃默里健康成果和质量中心进行的成果研究培训是候选人研究职业发展计划的最后组成部分。抗菌素耐药性和不适当的抗生素使用是主要的公共卫生问题。改善抗生素使用和减少抗菌素耐药性的最有效方法仍不清楚。该项目的目的是确定抗菌素使用团队是否改善了抗生素的使用和患者的结果，并减少了抗菌素耐药性。这项调查建议(1)进行一项随机试验，比较多学科抗菌药物使用小组与基于适应症的抗生素处方指南在改善抗生素使用和降低医疗成本方面的有效性，以及(2)进行干预性研究，以确定重症监护病房多学科抗菌药物使用小组查房对抗菌药物利用、抗菌治疗总成本和医院内病原菌耐药率的影响。

DESCRIPTION (provided by applicant): This proposal is part of an integrated career development plan comprised of advanced didactic training in clinical investigation and an intensive, mentored patient-oriented research experience with the goal of developing the skills and experience necessary for a successful, independent career in clinical investigation. The candidate's goal is to establish an independent, successful research program focusing on antimicrobial utilization and resistance. Didactic training will be undertaken as part of the research career development plan in order to extend upon the candidate's existing foundation in clinical research which was obtained through the Master of Science in Clinical Research (MSCR) degree. This additional didactic training provides the opportunity to study other technical and methodologic components integral to the proposed clinical research including outcomes research, cost-analysis, and behavioral epidemiology. The candidate's mentor and internal advisory committee are well-recognized, established clinical researchers in infectious diseases who are committed to fostering the candidate's career development and critically assessing the candidate's progress and ongoing research. Training in outcomes research at the Emory Center for Health Outcomes and Quality represents the final component of the candidate's research career development plan. Antimicrobial resistance and inappropriate antibiotic use are major public health problems. The most effective methods to improve antibiotic use and reduce antimicrobial resistance remain unclear. The purpose of this project is to determine if antimicrobial utilization teams improve antibiotic use and patient outcomes and reduce antimicrobial resistance. This investigation proposes to (1) conduct a randomized trial comparing the efficacy of a multidisciplinary antimicrobial utilization team versus indication based antibiotic prescribing guidelines in improving antibiotic use and reducing the cost of medical care, and (2) conduct an interventional study to determine the impact of a multidisciplinary antimicrobial utilization team rounds in the intensive care unit on antimicrobial utilization, total costs of antimicrobial therapy, and rates of resistance in nosocomial pathogens.