Benoit Stephen R, Nsa Wato, Richards Chesley L, Bratzler Dale W, Shefer Abigail M, Steele Lynn M, Jernigan John A
Division of Healthcare Quality Promotion, Centers for Disease Control and Preventation, Atlanta, Georgia, USA.
J Am Geriatr Soc. 2008 Nov;56(11):2039-44. doi: 10.1111/j.1532-5415.2008.01967.x.
To describe antimicrobial prescribing patterns in nursing homes.
Retrospective, observational study.
Total of 73 nursing homes in four U.S. states; study period was from September 1, 2001, through February 28, 2002.
Four thousand seven hundred eighty nursing home residents.
Number and type of antimicrobials, indication for their use, and resident and facility factors associated with antimicrobial use in nursing homes.
Of 4,780 residents, 2,017 (42%) received one or more antibiotic courses. Overall, residents received a mean of 4.8 courses/1,000 resident-days (mean facility range 0.4-23.5). In multivariable analysis, higher probability of nursing home discharge and of being categorized in the rehabilitation, extensive services, special care, or clinically complex Resource Utilization Groups were associated with higher rates of antimicrobial usage. Three drug classes accounted for nearly 60% of antimicrobial courses-fluoroquinolones (38%), first-generation cephalosporins (11%), and macrolides (10%). The most common conditions for which antimicrobials were prescribed were respiratory tract (33%) and urinary tract (32%) infections.
Antibiotic use is variable in nursing homes. Targeting educational and other antimicrobial use interventions to the treatment of certain clinical diagnoses and conditions may be an appropriate strategy for optimizing antimicrobial use in this setting.
描述疗养院中抗菌药物的处方模式。
回顾性观察研究。
美国四个州的73家疗养院；研究期间为2001年9月1日至2002年2月28日。
4780名疗养院居民。
抗菌药物的数量和类型、使用指征以及与疗养院抗菌药物使用相关的居民和机构因素。
在4780名居民中，2017名（42%）接受了一个或多个抗生素疗程。总体而言，居民平均每1000个居民日接受4.8个疗程（各机构平均范围为0.4 - 23.5）。在多变量分析中，疗养院出院概率较高以及被归类为康复、广泛服务、特殊护理或临床复杂资源利用组与抗菌药物使用率较高相关。三类药物占抗菌药物疗程的近60%——氟喹诺酮类（38%）、第一代头孢菌素（11%）和大环内酯类（10%）。开具抗菌药物最常见的病症是呼吸道感染（33%）和尿路感染（32%）。
疗养院中抗生素的使用情况各不相同。针对某些临床诊断和病症进行教育及其他抗菌药物使用干预可能是优化该环境中抗菌药物使用的合适策略。
