VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, UT 84148, USA.
J Antimicrob Chemother. 2012 Jun;67(6):1537-9. doi: 10.1093/jac/dks074. Epub 2012 Mar 7.
To assess the prevalence of, and the variation in, avoidable use of metronidazole in the Veterans Affairs (VA) healthcare system
Barcode Medication Administration (BCMA) data were retrospectively assessed for all patients hospitalized between January 2006 and December 2010 in acute-care wards of all VA medical centres (VAMCs) with complete BCMA data and at least 10 acute-care non-intensive care unit (ICU) beds. Potentially avoidable metronidazole days of therapy (DOT) were defined as the administration of metronidazole with another anti-anaerobic antibiotic on the same day for at least two consecutive days during the same hospitalization. Metronidazole was not considered redundant in combination with another anti-anaerobic agent within 28 days after a positive test for Clostridium difficile and during hospitalizations associated with discharge diagnosis codes for cholecystitis or cholangitis.
A total of 128 VAMCs satisfied the inclusion criteria. Over the study period there were a total of 782,821 DOT of metronidazole (57.4 DOT per 1000 patient-days), of which 183,267 (23.4%) fulfilled the criteria for avoidable metronidazole DOT. The percentage of avoidable metronidazole DOT remained stable over the study period (22.8% in 2006 and 22.9% in 2010) despite a decrease in overall metronidazole use. There was wide variation in the percentage of avoidable metronidazole DOT among facilities (2010: median 20.3%, IQR 15.3%-29.4%). Piperacillin/tazobactam was the most commonly administered drug on avoidable metronidazole DOT (56.8%).
Potentially avoidable use of metronidazole affected about a quarter of all days when metronidazole was given. The combination of metronidazole with piperacillin/tazobactam was particularly common and represents a possible target for antibiotic stewardship interventions.
评估退伍军人事务部（VA）医疗系统中甲硝唑的可避免使用的流行率和变化。
回顾性评估 2006 年 1 月至 2010 年 12 月期间，所有在 VA 医疗中心（VAMC）急性护理病房住院的患者的条码药物管理（BCMA）数据，这些病房必须具有完整的 BCMA 数据，且至少有 10 张急性护理非重症监护病房（ICU）床位。潜在可避免的甲硝唑治疗天数（DOT）定义为在同一住院期间至少连续两天，在同一天内同时使用甲硝唑和另一种抗厌氧菌抗生素。在艰难梭菌阳性检测后 28 天内，以及在与胆囊炎或胆管炎出院诊断代码相关的住院期间，甲硝唑与另一种抗厌氧菌药物联合使用时不被认为是多余的。
共有 128 个 VAMC 符合纳入标准。在研究期间，甲硝唑的总 DOT 为 782821 天（每 1000 个患者日 57.4 天），其中 183267 天（23.4%）符合可避免甲硝唑 DOT 的标准。尽管甲硝唑的总体使用量有所下降，但在研究期间，可避免甲硝唑 DOT 的百分比保持稳定（2006 年为 22.8%，2010 年为 22.9%）。各医疗机构之间可避免甲硝唑 DOT 的百分比差异很大（2010 年：中位数 20.3%，IQR 15.3%-29.4%）。哌拉西林/他唑巴坦是可避免使用甲硝唑 DOT 时最常使用的药物（56.8%）。
甲硝唑的潜在可避免使用影响了甲硝唑使用天数的约四分之一。甲硝唑与哌拉西林/他唑巴坦联合使用的情况特别常见，这可能是抗生素管理干预的目标。
