Antimicrobial Use in Dialysis Units

项目摘要 慢性血液透析(CHD)的人群正在迅速增长。由以下原因引起的感染率 抗菌素耐药菌(ARB)在该患者群体中是最高的。抗菌药物的使用是 ARB的发生和扩散的主要危险因素。缺乏量化抗菌药物使用的数据。 和CHD患者不适当的处方模式，这是医疗保健机构的优先人群 研究和质量。全面的抗菌管理计划，特别针对这个 门诊透析室的人口，还没有发展起来。 我们在两个门诊透析室启动了一项初步研究，以量化和描述不适当的情况 开出抗菌药的处方。我们的初步数据显示，27.5%的抗菌剂剂量是 根据国家指导方针，不适当地开出。第三代/第四代头孢菌素，其次是 万古霉素是最常见的不适当开出的抗菌药。这三个关键类别 不适当的处方是a]没有达到诊断感染的国家共识标准，b]缺乏 减少血液透析通路相关的抗菌治疗和c]外科预防 手术在术后24小时继续进行。 在这项提案中，我们将开发、实施和演示一种抗菌剂的有效性 减少门诊透析患者抗菌药物处方和不当处方的管理计划 单位。该计划将包括教育干预以及制度和社会/行为改变 战略。后者将涉及实施积极偏离办法。中断的时间 将采用系列设计，在干预前12个月期间每月收集数据，并在12个月- 干预后一个月。这项建议的具体目标是：目标1--证明其有效性 一项减少门诊血液透析病房抗菌药物使用的抗菌药物管理计划。目标2- 证明抗菌素管理计划在减少不当行为方面的有效性 门诊血液透析室抗菌药物的应用。目标3--展示这项技术的成本效益 抗菌管理计划。证明这一抗菌管理计划的有效性将 在冠心病人群中提供未得到满足和早就应该满足的需求，并最终将改善 通过减少ARB和ARB感染的患病率，这一患者群体。

Project Summary 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 prescribing 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.