Clinical Microbiology and Public Health Laboratory, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough City Hospital, Bretton Gate, Peterborough, PE3 9GZ, UK.
QJM. 2011 May;104(5):411-9. doi: 10.1093/qjmed/hcq228. Epub 2010 Nov 28.
Restrictions in prescribing broad spectrum antimicrobials have been part of a strategy to reduce Clostridium difficile cases in the UK in recent years. However, there has been little work on assessing the safety of alternative antimicrobial agents.
We performed an uncontrolled prospective observational survey over a 1-year period to determine the effectiveness and safety of a new antimicrobial stewardship programme in a district hospital in the UK.
In total, 227 Gram-negative bacteraemias (203 episodes) occurred in the study period. Guidelines were adequate in 194 of 203 (95%) episodes and 163 episodes (80.2%) received adequate therapy. Patients in the inadequate therapy group had >2-fold increased likelihood of death [odds ratio (OR) = 2.63, 95% confidence interval (CI) = 1.09-6.34] within 30 days and >6-fold increased risk of death (OR = 6.40, 95% CI = 2.22-18.45) within 1 week when compared to patients in the adequate therapy group. Failure to administer gentamicin was the principal reason for not following the guidelines (18 episodes). Eight of these 18 episodes were susceptible to cefuroxime and two of these patients died.
Adherence to the guidelines was associated with a correct empirical antibiotic choice and reduced mortality. This study also demonstrates the importance of adopting guidelines based on local susceptibility patterns.
近年来，限制广谱抗生素的使用一直是英国减少艰难梭菌感染病例的策略之一。然而，对于替代抗菌药物的安全性评估工作却很少。
我们在英国的一家地区医院进行了为期 1 年的非对照前瞻性观察性调查，以确定新的抗菌药物管理计划的有效性和安全性。
在研究期间，共发生了 227 例革兰氏阴性菌菌血症（203 例）。在 203 例（95%）病例中，指南是充分的，163 例（80.2%）接受了充分的治疗。在治疗不足的患者中，30 天内死亡的可能性增加了两倍以上[比值比（OR）=2.63，95%置信区间（CI）=1.09-6.34]，而在 1 周内死亡的风险增加了 6 倍以上（OR=6.40，95% CI=2.22-18.45）。与治疗充分的患者相比。不使用庆大霉素是不遵循指南的主要原因（18 例）。这 18 例中有 8 例对头孢呋辛敏感，其中 2 例患者死亡。
遵循指南与正确的经验性抗生素选择和降低死亡率相关。本研究还表明，根据当地药敏模式采用指南的重要性。
