感染性疾病会诊对抗菌药物处方的模式及影响
The pattern and impact of infectious diseases consultation on antimicrobial prescription.
作者信息
Al-Tawfiq Jaffar A
机构信息
Medical Department, Specialty Internal Medicine Unit, Dhahran Health Center, Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Saudi Arabia.
出版信息
J Glob Infect Dis. 2013 Apr;5(2):45-8. doi: 10.4103/0974-777X.112266.
OBJECTIVES
Inclusion of infectious disease (ID) physicians in the care of patients with possible infection can favorably affect antibiotic usage. The aim of this study was to evaluate the role of the ID consultations in reducing inappropriate antibiotic usage.
MATERIALS AND METHODS
This is a prospective study evaluating all adult ID consultations from January 2006 to December 2009. A total of 1444 consultation requests were recorded during the 4-year period.
RESULTS
The most frequent consultations were from cardiology (23.1%), orthopedics (8.2%), general medicine (7.8%), hematology-oncology (7.8%), gastroenterology (7.3%), and pulmonary/critical care (7.1%). The main reason for consultation was for the choice of antibiotics (75%). The commonest diagnoses prior to consultation were fever (14.7%), bacteremia (9.1%), and urinary tract infection (8.4%). Bacteremia was documented in 21.4% of cases and 12.9% were found to have no identifiable focus of infection. Antimicrobial therapy was changed in 58.7% and antimicrobials were discontinued in 14.7% of cases. The number of antimicrobial therapy was one (49.7% and 49.9%) and two (24% and 17.6%, P = 0.0001) before and after the consultation, respectively. In addition, 17.3% and 26.9% (P = 0.0001) received no antimicrobial agents before and after ID consultation.
CONCLUSION
ID consultation is important to reduce inappropriate antimicrobial therapy and to limit the number of dual therapy.
目的
让感染病（ID）科医生参与可能感染患者的护理工作，可对抗生素使用产生积极影响。本研究旨在评估ID会诊在减少不当抗生素使用方面的作用。
材料与方法
这是一项前瞻性研究，评估了2006年1月至2009年12月期间所有成人ID会诊情况。在这4年期间共记录了1444次会诊请求。
结果
最常见的会诊来自心脏病学（23.1%）、骨科（8.2%）、普通内科（7.8%）、血液肿瘤学（7.8%）、胃肠病学（7.3%）和肺科/重症监护（7.1%）。会诊的主要原因是抗生素的选择（75%）。会诊前最常见的诊断是发热（14.7%）、菌血症（9.1%）和尿路感染（8.4%）。21.4%的病例记录有菌血症，12.9%未发现可识别的感染源。58.7%的病例抗菌治疗方案发生了改变，14.7%的病例停用了抗菌药物。会诊前后使用抗菌药物的数量分别为一种（49.7%和49.9%）和两种（24%和17.6%，P = 0.0001）。此外，ID会诊前后分别有17.3%和26.9%（P = 0.0001）未接受抗菌药物治疗。
结论
ID会诊对于减少不当抗菌治疗及限制联合治疗的数量很重要。
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