Department of Medicine, Division of General Internal Medicine, North Shore University Hospital, Manhasset, NY 11030, USA. .
J Hosp Med. 2012;7 Suppl 1:S34-43. doi: 10.1002/jhm.978.
The care of patients with serious infections both within and outside healthcare settings is increasingly complicated by the high prevalence of resistant or multidrug-resistant (MDR) pathogens. Moreover, infections caused by MDR versus susceptible bacteria or other pathogens are associated with significantly higher mortality, length of hospital stay, and healthcare costs. Antimicrobial misuse or overuse is the primary driver for development of antimicrobial resistance, suggesting that better use of antimicrobials will translate into improved patient outcomes, more efficient use of hospital resources, and lowered healthcare costs. Antimicrobial stewardship refers to the various practices and procedures utilized to optimize antimicrobial use. The primary goal of antimicrobial stewardship is to improve patient outcomes and lower antimicrobial resistance and other unintended consequences of antimicrobial therapy. Secondary goals are to reduce length of hospital stays and healthcare-related costs. Hospitalists are increasingly involved in the care of hospitalized patients throughout the United States. Expertise in managing conditions requiring hospitalization, and experience in quality improvement across a wide range of clinical conditions, make hospitalists well positioned to participate in the development and implementation of hospital-based antimicrobial stewardship programs designed to improve patient outcomes, reduce antimicrobial resistance, and provide more efficient and lower-cost hospital care.
严重感染患者的护理，无论是在医疗保健环境内还是外，都因耐药或多药耐药（MDR）病原体的高流行率而变得越来越复杂。此外，与敏感细菌或其他病原体引起的感染相比，MDR 感染与更高的死亡率、住院时间和医疗保健成本相关。抗菌药物的不合理使用或过度使用是抗菌药物耐药性发展的主要驱动因素，这表明更好地使用抗菌药物将转化为改善患者预后、更有效地利用医院资源和降低医疗保健成本。抗菌药物管理是指优化抗菌药物使用所采用的各种实践和程序。抗菌药物管理的主要目标是改善患者预后，降低抗菌药物耐药性和抗菌药物治疗的其他意外后果。次要目标是减少住院时间和与医疗保健相关的成本。 在美国，越来越多的医院医生参与住院患者的护理。他们在需要住院治疗的疾病管理方面具有专业知识，并且在广泛的临床条件下具有质量改进经验，这使医院医生能够很好地参与制定和实施旨在改善患者预后、降低抗菌药物耐药性以及提供更高效、低成本的医院护理的基于医院的抗菌药物管理计划。
