Clinic for Internal Medicine, Regionalspital Emmental, Burgdorf, Switzerland.
Swiss Med Wkly. 2013 May 27;143:w13796. doi: 10.4414/smw.2013.13796. eCollection 2013.
Unnecessary treatment of asymptomatic bacteriuria and overuse of urinary catheters in hospitals are of concern regarding antimicrobial resistance and patient safety, respectively. We investigated the effectiveness of a multifaceted intervention in reducing urinary catheter use and unnecessary prescription of antibiotics for asymptomatic bacteriuria in hospitalised patients in a clinic for internal medicine.
Data were collected retrospectively from all inpatients during a 3-month period both before and after a multifaceted intervention from the Clinic for Internal Medicine of our secondary care hospital. The intervention consisted of implementation of guidelines, establishment of a standard for urinary catheter management, introduction of restricted orders and a reminder of indwelling catheters, as well as lectures and internet-based learning focusing on asymptomatic bacteriuria.
The incidence rate of urinary catheter days decreased significantly from 27 to 17 catheter days per 100 patient days (incidence rate ratio 0.61, 95% confidence interval 0.57-0.67). The incidence rate of unnecessary antibiotic treatment days for asymptomatic bacteriuria dropped significantly from 22 to 10 treatment days per 1,000 patient days (incidence rate ratio 0.46, 95% confidence interval 0.33-0.63).
A multifaceted intervention was effective in reducing both urinary catheter days and inappropriate antibiotic use for asymptomatic bacteriuria.
在医院中，无症状菌尿症的不必要治疗和尿管的过度使用分别与抗菌药物耐药性和患者安全相关。我们在内科诊所调查了一项多方面干预措施在减少住院患者尿管使用和不必要的无症状菌尿症抗生素处方方面的效果。
从我们的二级保健医院内科诊所的所有住院患者在实施多方面干预前后的 3 个月期间，回顾性地收集数据。干预措施包括实施指南、建立尿管管理标准、引入限制医嘱和留置尿管提醒、以及针对无症状菌尿症的讲座和基于互联网的学习。
尿管日的发生率从 27 下降至 17 个（发生率比 0.61，95%置信区间 0.57-0.67）。不必要的抗生素治疗无症状菌尿症的天数发生率从 22 下降至 10 天（发生率比 0.46，95%置信区间 0.33-0.63）。
多方面干预措施可有效减少尿管日和无症状菌尿症的不合理抗生素使用。
