Katz P R, Beam T R, Brand F, Boyce K
Department of Medicine, State University of New York, Buffalo.
Arch Intern Med. 1990 Jul;150(7):1465-8.
Antibiotic usage patterns were studied in two nonproprietary nursing homes that included 720 intermediate care and skilled nursing home beds. Medical records of residents receiving antibiotics were reviewed every fourth month for 1 year. Of 181 antibiotic prescriptions written for indications other than prophylaxis, 41% were for presumed urinary tract infections, 35% for respiratory tract infections, and 14% for skin/soft-tissue infections. The majority of antibiotic prescriptions (54%) were made by telephone order. Cultures were obtained in 60% of suspected infections; two thirds of cultures were of the urine. Antibiotics were changed during the course of therapy in only 12% of cases. Eighty-one percent of residents treated with antibiotics improved or were cured, 9.5% were hospitalized or died, and an additional 9.5% failed to improve but remained in the nursing home. Fever was present in 48% of cases prior to treatment, but had no predictive value for patient outcome. We conclude that antibiotic treatment in the nursing home is often initiated in the absence of fever, culture information, or examination of the patient. Empiric prescription of antibiotics in this setting generally is associated with favorable clinical course.
在两家非私立养老院中对抗生素使用模式进行了研究，这两家养老院共有720张中级护理和专业护理床位。对接受抗生素治疗的居民的病历进行了为期1年的每四个月一次的审查。在为非预防性适应症开具的181份抗生素处方中，41%用于疑似尿路感染，35%用于呼吸道感染，14%用于皮肤/软组织感染。大多数抗生素处方（54%）是通过电话医嘱开具的。60%的疑似感染病例进行了培养；三分之二的培养样本是尿液。仅12%的病例在治疗过程中更换了抗生素。接受抗生素治疗的居民中，81%病情改善或治愈，9.5%住院或死亡，另有9.5%病情未改善但仍留在养老院。48%的病例在治疗前有发热症状，但对患者预后没有预测价值。我们得出结论，养老院中的抗生素治疗往往在没有发热、培养信息或对患者进行检查的情况下开始。在这种情况下，抗生素的经验性处方通常与良好的临床病程相关。
