Development, Implementation and Evaluation of Novel Strategies to Reduce Inapprop

描述（由研究者提供）：在卫生保健机构中不适当使用抗菌素会导致严重的公共卫生后果，因为这会促进抗菌素耐药病原体的产生。在急性护理和长期护理环境中，尿路感染（uti）在不适当的抗菌药物使用中占很大比例，因为它们很常见，而且通常是针对无症状细菌尿（ASB）开出治疗处方，而无症状细菌尿（ASB）是不适合治疗的。此外，许多有症状的尿路感染可归因于过度使用导尿管，因此是可以预防的。本提案的中心假设是，设计用于预防和适当管理尿路感染的基于算法的干预措施将安全地减少医疗系统中抗菌素的使用并降低抗菌素耐药率。本提案的具体目的是：1)确定三级医疗中心及其附属长期护理设施和门诊诊所中尿路感染治疗不当的频率、原因和不良影响；2).检查ASB不必要的抗菌治疗对耐药病原体的定植和传播的影响，包括耐药革兰氏阴性杆菌、MRSA和耐万古霉素肠球菌；3)确定基于算法的尿路感染预防和管理干预，结合减少其他适应症氟喹诺酮类抗生素的不必要使用的干预，是否会安全地减少氟喹诺酮类药物和总抗菌药物的使用，并降低卫生保健系统中抗菌药物的耐药率。除尿路感染外，氟喹诺酮类抗生素通常被滥用于其他综合征。因此，将预防和管理尿路感染的干预措施与减少氟喹诺酮类药物在其他适应症中的过度使用的干预措施相结合，将最大限度地降低这些药物施加的选择压力。拟议的研究将为卫生保健机构提供一个模型，以预防和适当管理尿路感染，并减少抗微生物药物耐药性感染的发展。

DESCRIPTION (provided by investigator): Inappropriate use of antimicrobials in healthcare facilities results in serious public health consequences due to promotion of antimicrobial-resistant pathogens. Urinary tract infections (UTIs) account for a significant proportion of inappropriate antimicrobial use in acute care and long-term care settings because they are common and because treatment is often prescribed for asymptomatic bacteriuria (ASB), for which therapy is not indicated. In addition, many symptomatic UTIs are attributable to overuse of urinary catheters, and are therefore preventable. The central hypothesis of this proposal is that an algorithm-based intervention designed to prevent and appropriately manage UTI will safely decrease antimicrobial use and reduce rates of antimicrobial resistance in a healthcare system. The specific aims of this proposal are to: 1). determine the frequency of, reasons for, and adverse effects of inappropriate treatment of UTI in a tertiary care medical center and affiliated long-term care facilities and outpatient clinics; 2). examine the effect of unnecessary antimicrobial treatment of ASB on colonization and dissemination of antimicrobial-resistant pathogens, including antimicrobial-resistant gram- negative bacilli, MRSA, and vancomycin-resistant Enterococcus; and 3). determine if an algorithm-based intervention for prevention and management of UTI, in combination with an intervention to decrease unnecessary use of fluoroquinolone antibiotics for other indications, will safely decrease fluoroquinolone and total antimicrobial use and reduce rates of antimicrobial resistance in a healthcare system. Fluoroquinolone antibiotics are commonly overused for other syndromes in addition to UTI. Therefore, combining the intervention for prevention and management of UTI with an intervention to decrease overuse of fluoroquinolones for other indications will maximize the potential to significantly reduce selective pressure exerted by these agents. The proposed studies will provide a model for healthcare facilities to prevent and appropriately manage UTIs and to reduce the development of antimicrobial-resistant infections.