Meyer Elisabeth, Buttler Juergen, Schneider Christian, Strehl Egid, Schroeren-Boersch Barbara, Gastmeier Petra, Ruden Henning, Zentner Josef, Daschner Franz D, Schwab Frank
Institute of Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Hugstetter Str 55, Freiburg, Germany.
J Antimicrob Chemother. 2007 Jun;59(6):1148-54. doi: 10.1093/jac/dkm088. Epub 2007 Apr 13.
To evaluate the impact of an intervention to reduce the duration of antibiotic treatment for pneumonia in a neurosurgical intensive care unit (ICU). The usage of antibiotics and the resultant costs were examined using interrupted time series analysis while resistance and device-associated infection rates are also described.
In January 2004, revised guidelines for the use of antibiotics were implemented. As a consequence of this, the duration of antibiotic therapy for nosocomial pneumonia was reduced from 14 to 7 days, while for community-acquired pneumonia the period fell from 10 to 5 days. The effect on the antibiotic use density [AD; expressed as defined daily doses (DDD) per 1000 patient days (pd)] was calculated by segmented regression analysis of interrupted time series for the 24 months prior to (2002 and 2003) and after the intervention (2004 and 2005).
The intervention was associated with a significant decrease in total AD from 949.8 to 626.7 DDD/1000 pd after the intervention. This was mainly due to reduced consumption of second-generation cephalosporins (-100.6 DDD/1000 pd), imidazoles (- 100.3 DDD/1000 pd), carbapenems (-33.3 DDD/1000 pd), penicillins with beta-lactamase inhibitor (-33.5 DDD/1000 pd) and glycopeptides (-30.2 DDD/1000 pd). Glycopeptide reduction might be associated with a significant decrease in the proportion of methicillin-resistant Staphylococcus aureus (8.4% before and 2.9% after the intervention). Similarly, total antibiotic costs/pd (Euro) showed a significant decrease from 13.16 Euro/pd before to 7.31 euro/pd after the intervention. This is a saving of 5.85 Euro/pd. The incidence of patients dying with pneumonia did not change significantly.
The most conservative estimate of segmented regression analysis over a 48 month period showed that halving the duration of treatment for pneumonia results in a reduction of over 30% in antibiotic consumption and costs. Because respiratory infections are most common in ICU patients, interventions targeting a reduction in the duration of treatment of pneumonia might be extremely worthwhile.
评估一项旨在缩短神经外科重症监护病房（ICU）肺炎患者抗生素治疗时长的干预措施的影响。采用间断时间序列分析来研究抗生素的使用情况及由此产生的费用，同时描述耐药性和器械相关感染率。
2004年1月实施了修订后的抗生素使用指南。由此，医院获得性肺炎的抗生素治疗时长从14天减至7天，社区获得性肺炎的治疗时长从10天减至5天。通过对干预前（2002年和2003年）及干预后（2004年和2005年）24个月的间断时间序列进行分段回归分析，计算对抗生素使用密度[AD；以每1000患者日（pd）的限定日剂量（DDD）表示]的影响。
干预措施实施后，总AD从949.8降至626.7 DDD/1000 pd，降幅显著。这主要归因于第二代头孢菌素（-100.6 DDD/1000 pd）、咪唑类（-100.3 DDD/1000 pd）、碳青霉烯类（-33.3 DDD/1000 pd）、含β-内酰胺酶抑制剂的青霉素类（-33.5 DDD/1000 pd）和糖肽类（-30.2 DDD/1000 pd）的消耗量减少。糖肽类消耗量的减少可能与耐甲氧西林金黄色葡萄球菌比例的显著下降有关（干预前为8.4%，干预后为2.9%）。同样，每患者日的抗生素总费用（欧元）从干预前的13.16欧元/患者日显著降至干预后的7.31欧元/患者日。这意味着每患者日节省5.85欧元。因肺炎死亡的患者发生率没有显著变化。
48个月期间分段回归分析的最保守估计表明，将肺炎治疗时长减半可使抗生素消耗量和费用降低超过30%。由于呼吸道感染在ICU患者中最为常见，旨在缩短肺炎治疗时长的干预措施可能极具价值。
