Barlam Tamar F, DiVall Margarita
School of Medicine, Boston University Medical Center, Boston, MA 02118, USA.
Infect Control Hosp Epidemiol. 2006 Jul;27(7):695-703. doi: 10.1086/503346. Epub 2006 Jun 21.
Improvements in antibiotic prescribing to reduce bacterial resistance and control hospital costs is a growing priority, but the way to accomplish this is poorly defined. Our goal was to determine whether certain antibiotic stewardship interventions were universally instituted and accepted at top US academic centers and to document what interventions, if any, are used at both teaching and community hospitals within a geographic area.
Two surveys were conducted. In survey 1, detailed phone interviews were performed with the directors of antibiotic stewardship programs at 22 academic medical centers that are considered among the best for overall medical care in the United States or as leaders in antibiotic stewardship programs. In survey 2, teaching and community hospitals throughout Massachusetts were surveyed to ascertain what antibiotic oversight program components were present.
In survey 1, each of the 22 participating hospitals had instituted interventions to improve antibiotic prescribing, but none of the interventions were universally accepted as essential or effective. In survey 2, of 97 surveys that were mailed to prospective participants, a total of 54 surveys from 19 teaching hospitals and 35 community hospitals were returned. Ninety-five percent of the teaching hospitals had a restricted formulary, compared with 49% of the community hospitals, and 89% of teaching hospitals had an antibiotic approval process, compared with 29% of community hospitals.
There was great variability among the approaches to the oversight of antibiotic prescribing at major academic hospitals. Antibiotic management interventions were lacking in more than half of the Massachusetts community hospitals surveyed. More research is needed to define the best antibiotic stewardship interventions for different hospital settings.
改进抗生素处方以降低细菌耐药性并控制医院成本，这一需求日益迫切，但实现此目标的方法尚不明确。我们的目标是确定某些抗生素管理干预措施在美国顶尖学术中心是否普遍实施并被接受，并记录在一个地理区域内的教学医院和社区医院所采用的干预措施（若有）。
进行了两项调查。在调查1中，对22家学术医疗中心的抗生素管理项目主任进行了详细的电话访谈，这些中心在美国整体医疗护理方面被认为是最佳的，或者是抗生素管理项目的领导者。在调查2中，对马萨诸塞州的教学医院和社区医院进行了调查，以确定存在哪些抗生素监督项目组成部分。
在调查1中，22家参与调查的医院均已采取干预措施来改进抗生素处方，但没有一种干预措施被普遍认为是必不可少或有效的。在调查2中，向潜在参与者邮寄了97份调查问卷，共收到来自19家教学医院和35家社区医院的54份回复。95%的教学医院有受限的药品处方集，而社区医院的这一比例为49%；89%的教学医院有抗生素审批流程，而社区医院的这一比例为29%。
主要学术医院在抗生素处方监督方法上存在很大差异。在接受调查的马萨诸塞州社区医院中，超过一半缺乏抗生素管理干预措施。需要更多研究来确定针对不同医院环境的最佳抗生素管理干预措施。
