Service de réanimation médicale, hôpital l'Archet-1, CHU de Nice, 151 route Saint-Antoine-de-Ginestière, Nice cedex 3, France.
Med Mal Infect. 2011 Sep;41(9):480-5. doi: 10.1016/j.medmal.2010.12.022. Epub 2011 Jul 20.
The study's objective was to assess the impact of a professional multifaceted intervention designed to improve the quality of inpatient empirical therapeutic antibiotic courses at the time of their reassessment, i.e. 24 to 96 hours after treatment initiation.
We conducted a 5-month prospective pre- and post-intervention study in a medical Intensive Care Unit (ICU) in a teaching hospital, using time-series analysis. The intervention was a multifaceted professional intervention combining systematic 3-weekly visits of an infectious diseases specialist to discuss all antibiotic therapies, interactive teaching courses, and daily contact with a microbiologist.
Eighty-one antibiotic prescriptions were assessed, 37 before and 44 after the intervention. The prevalence of adequate antibiotic prescriptions was high and not statistically different before and after the intervention (73% vs. 80%, P=0.31), both for sudden change (P=0.67) and linear trend (P=0.055), using interrupted time-series analysis. The intervention triggered a more frequent reassessment of the diagnosis between day 2 and day 4 (11% vs. 32%, P=0.02) and slightly improved the adaptation of antibiotic therapies to positive microbiology (25% before vs. 50% after, P=0.18).
Our multifaceted intervention may have improved the quality of antibiotic therapies around day 3 of prescription, but the difference did not reach statistical significance, possibly because of a ceiling effect.
本研究旨在评估一项旨在提高治疗起始后 24 至 96 小时再次评估时住院经验性治疗抗生素疗程质量的专业多方面干预措施的效果。
我们在一家教学医院的内科重症监护病房（ICU）进行了一项为期 5 个月的前瞻性干预前后研究，采用时间序列分析。干预措施是一种多方面的专业干预，包括感染病专家每 3 周对所有抗生素治疗进行系统性访问、互动教学课程以及与微生物学家进行日常联系。
共评估了 81 份抗生素处方，干预前 37 份，干预后 44 份。适当抗生素处方的流行率较高，且在干预前后无统计学差异（73%与 80%，P=0.31），无论是突变更新（P=0.67）还是线性趋势（P=0.055），均采用中断时间序列分析。干预措施促使在第 2 天至第 4 天更频繁地重新评估诊断（11%与 32%，P=0.02），并略微改善了抗生素治疗对阳性微生物学的适应性（25%与 50%，P=0.18）。
我们的多方面干预措施可能在处方后第 3 天左右改善了抗生素治疗的质量，但差异没有达到统计学意义，可能是因为存在上限效应。
