Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Nobels väg 9, SE-171 77 Stockholm, Sweden.
J Antimicrob Chemother. 2011 Nov;66(11):2659-66. doi: 10.1093/jac/dkr312. Epub 2011 Sep 5.
To assess the impact of a multifaceted educational intervention concerning treatment of infections in the nursing home setting.
We used a cluster randomized controlled trial. Fifty-eight nursing homes in Sweden were randomly assigned either to educational intervention or control. The intervention consisted of small educational group sessions with nurses and physicians, feedback on prescribing, presentation of guidelines and written materials. The primary outcome was the proportion of quinolones prescribed for lower urinary tract infection (UTI) in women. Secondary outcomes were for all infections: number of UTIs per resident, proportion of recorded infections treated with an antibiotic, proportion of infections handled by physicians as 'wait and see', and for lower UTI in women, proportion of nitrofurantoin.
Of the 58 nursing homes, 46 completed the study. A total of 702 and 540 infections were recorded pre- and post-intervention. The proportion of quinolones decreased significantly in the intervention and control groups, by -0.196 (9/93 to 36/123) and -0.224 (4/66 to 31/109), respectively [95% confidence interval (CI) -0.338, -0.054 and -0.394, -0.054], but the difference between intervention and control groups was not significant, with an absolute risk reduction of 0.028 (95% CI -0.193, 0.249). The changes in proportion of infections treated with antibiotics and proportion of infections handled by physicians as 'wait and see' was significant in comparison with controls: -0.124 (95% CI -0.228, -0.019) and 0.143 (95% CI 0.047, 0.240). No intervention effect could be seen for the other outcomes.
The educational intervention had no effect on the primary outcome, but decreased the overall prescribing of antibiotics.
评估针对疗养院感染治疗的多方面教育干预的效果。
我们采用了一项集群随机对照试验。瑞典的 58 家疗养院被随机分配到教育干预组或对照组。干预措施包括小的教育小组会议，内容为护士和医生，处方反馈，指南介绍和书面材料。主要结果是女性下尿路感染（UTI）中喹诺酮类药物的处方比例。次要结果是所有感染：每位居民的 UTI 数量，记录的感染中用抗生素治疗的比例，医生作为“静观其变”处理的感染比例，以及女性下尿路感染中，呋喃妥因的比例。
在 58 家疗养院中，有 46 家完成了研究。干预前和干预后分别记录了 702 例和 540 例感染。喹诺酮类药物的比例在干预组和对照组中均显著下降，分别为-0.196（9/93 至 36/123）和-0.224（4/66 至 31/109）[95%置信区间（CI）-0.338，-0.054 和-0.394，-0.054]，但干预组与对照组之间的差异无统计学意义，绝对风险降低 0.028（95%CI-0.193，0.249）。与对照组相比，抗生素治疗的感染比例和医生作为“静观其变”处理的感染比例的变化具有统计学意义：-0.124（95%CI-0.228，-0.019）和 0.143（95%CI 0.047，0.240）。其他结果未见干预效果。
教育干预对主要结果没有影响，但减少了抗生素的总体处方。
