自肺炎绩效指标设立以来，ED 对急性呼吸道疾病使用抗生素的情况。

ED antibiotic use for acute respiratory illnesses since pneumonia performance measure inception.

机构信息

Department of Emergency Medicine, University of California San Francisco, San Francisco, CA 94143, USA.

出版信息

Am J Emerg Med. 2010 Jan;28(1):23-31. doi: 10.1016/j.ajem.2008.09.023.

DOI:10.1016/j.ajem.2008.09.023

PMID:20006197

Abstract

OBJECTIVE

The study aimed to determine if emergency department (ED)-administered antibiotics for patients discharged home with nonpneumonia acute respiratory tract infections (ARIs) have increased since national pneumonia performance measure implementation, including antibiotic administration within 4 hours of arrival.

DESIGN

Time series analysis.

SETTING

Six university and 7 Veterans Administration EDs participating in the Improving Antibiotic Use for Acute Care Treatment (IMPAACT) trial (randomized educational intervention to reduce antibiotics for bronchitis).

PARTICIPANTS

Randomly selected adult (age >18 years) ED visits for acute cough, diagnosed with nonpneumonia ARIs, discharged home during winters (November-February) of 2003 to 2007.

MAIN OUTCOME

Time trend in ED-administered antibiotics, adjusted for patient demographics, comorbidities, vital signs, ED length of stay, IMPAACT intervention status, geographic region, Veterans Administration/university setting, and site and provider level clustering.

RESULTS

Six thousand four hundred seventy-six met study criteria. Three hundred ninety-four (6.1%) received ED-administered antibiotics. Emergency department-administered antibiotics did not increase across the study period among all IMPAACT sites (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.76-1.01) after adjusting for age, congestive heart failure history, temperature higher than 100 degrees F, heart rate more than 100, blood cultures obtained, diagnoses, and ED length of stay. The ED-administered antibiotic rate decreased at IMPAACT intervention (OR, 0.80; 95% CI, 0.69-0.93) but not nonintervention sites (OR, 1.04; 95% CI, 0.91-1.19). Adjusted proportions receiving ED-administered antibiotics were 6.1% (95% CI, 2.7%-13.2%) for 2003 to 2004; 4.8% (95% CI, 2.2%-10.0%) for 2004 to 2005; 4.6% (95% CI, 2.7%-7.8%) for 2005 to 2006; and 4.2% (95% CI, 2.2%-8.0%) for 2006 to 2007.

CONCLUSIONS

Emergency department-administered antibiotics did not increase for patients with acute cough discharged home with nonpneumonia ARIs since pneumonia antibiotic timing performance measure implementation in these academic EDs.

摘要

目的

本研究旨在确定自国家肺炎治疗效果衡量标准实施以来，对于因非肺炎急性呼吸道感染（ARI）而被送回家的患者，在急诊科（ED）开具的抗生素是否有所增加，包括在到达后 4 小时内开具抗生素。

设计

时间序列分析。

设置

参与改善急性护理抗生素使用效果（IMPAACT）试验的六所大学和七所退伍军人事务部 ED（一项减少支气管炎抗生素使用的随机教育干预）。

参与者

2003 年至 2007 年冬季（11 月至 2 月）期间，在因急性咳嗽、被诊断为非肺炎 ARI 而随机选择的成年（年龄＞18 岁）ED 就诊者中，选择被送回家的患者。

主要结局

根据患者人口统计学、合并症、生命体征、ED 住院时间、IMPAACT 干预状态、地理位置、退伍军人事务部/大学设置、以及站点和提供者级别聚类，调整后 ED 开具抗生素的时间趋势。

结果

符合研究标准的患者有 6476 例。其中 394 例（6.1%）接受了 ED 开具的抗生素。调整年龄、充血性心力衰竭史、体温高于 100 华氏度、心率超过 100、血培养、诊断和 ED 住院时间后，在所有 IMPAACT 地点，研究期间 ED 开具抗生素的比例并未增加（比值比 [OR]，0.88；95%置信区间 [CI]，0.76-1.01）。IMPAACT 干预组（OR，0.80；95%CI，0.69-0.93）而非非干预组（OR，1.04；95%CI，0.91-1.19）开具的 ED 抗生素比例降低。接受 ED 开具抗生素的调整比例为：2003 年至 2004 年为 6.1%（95%CI，2.7%-13.2%）；2004 年至 2005 年为 4.8%（95%CI，2.2%-10.0%）；2005 年至 2006 年为 4.6%（95%CI，2.7%-7.8%）；2006 年至 2007 年为 4.2%（95%CI，2.2%-8.0%）。