Pharmacy Department, King's College Hospital, London, UK.
J Antimicrob Chemother. 2011 Sep;66(9):2168-74. doi: 10.1093/jac/dkr253. Epub 2011 Jun 14.
To evaluate the impact of an 'intervention' consisting of revised antibiotic guidelines for empirical treatment of common infections and enhanced stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection (CDI).
This was a retrospective, quasi-experimental study using interrupted time series (ITS) over 12 months before and after the intervention. The setting was adult medical and surgical wards in University Hospital Lewisham, an acute general hospital in London. The intervention was introduced in April 2006. Revised guidelines avoided broad-spectrum antibiotics, e.g. fluoroquinolones, cephalosporins, clindamycin, amoxicillin and co-amoxiclav, as they were considered to be 'high risk' for CDI. Instead, 'low risk' antibiotics such as penicillin, clarithromycin, doxycycline, gentamicin, vancomycin, trimethoprim and nitrofurantoin were recommended. Changes in antibiotic usage and incidence of CDI before and after the intervention were compared using segmented regression analysis. The negative binomial model was used to analyse the time series to estimate the CDI incidence rate ratio (IRR) following the intervention.
The intervention was associated with a significant reduction in the use of fluoroquinolones by 105.33 defined daily doses (DDDs)/1000 occupied bed-days (OBDs) per month [95% confidence interval (CI) 34.18-176.48, P < 0.001] and cephalosporins by 45.93 DDDs/1000 OBDs/month (95% CI 24.11-67.74, P < 0.0001). There was no significant change in total antibiotic, clindamycin, amoxicillin or co-amoxiclav use. There was a significant decrease in CDI following the intervention [IRR 0.34 (0.20-0.58), P < 0.0001].
Revised antibiotic guidelines and enhanced stewardship was associated with a significant stepwise reduction in the use of cephalosporins and fluoroquinolones and a significant decrease in the incidence of CDI.
评估一项“干预措施”的影响，该措施包括修订治疗常见感染的经验性抗生素指南和加强管理，以减少广谱抗生素的使用，并降低艰难梭菌感染（CDI）的发生率。
这是一项回顾性、准实验研究，采用干预前后 12 个月的中断时间序列（ITS）。研究地点为伦敦刘易斯汉姆大学医院的成人内科和外科病房，这是一家急性综合医院。干预措施于 2006 年 4 月推出。修订后的指南避免使用氟喹诺酮类、头孢菌素类、克林霉素、阿莫西林和复方阿莫西林等“高风险”抗生素，因为这些抗生素被认为与 CDI 相关。相反，推荐使用青霉素、克拉霉素、多西环素、庆大霉素、万古霉素、甲氧苄啶和呋喃妥因等“低风险”抗生素。使用分段回归分析比较干预前后抗生素使用和 CDI 发生率的变化。采用负二项式模型对时间序列进行分析，以估计干预后 CDI 的发病率比（IRR）。
该干预措施与氟喹诺酮类药物的使用量显著减少 105.33 定义日剂量（DDD）/1000 占用病床日（OBD）/月有关[95%置信区间（CI）34.18-176.48，P<0.001]，头孢菌素类药物的使用量减少 45.93 DDD/1000 OBD/月（95%CI 24.11-67.74，P<0.0001）。总抗生素、克林霉素、阿莫西林或复方阿莫西林的使用量没有显著变化。干预后 CDI 显著减少[IRR 0.34（0.20-0.58），P<0.0001]。
修订抗生素指南和加强管理与头孢菌素类和氟喹诺酮类药物使用量的显著逐步减少以及 CDI 发生率的显著降低有关。
