Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Pediatrics and Biomedical Informatics, Vanderbilt University, Nashville, TN.
Am J Infect Control. 2014 Feb;42(2):100-5. doi: 10.1016/j.ajic.2013.09.018.
The Johns Hopkins Children's Medical and Surgery Center developed a Web-based Antimicrobial Stewardship Program (ASP) in 2005. The present study aimed to assess longitudinal antimicrobial request and approval patterns for this ASP.
We analyzed a total of 16,229 antimicrobial requests for 3,542 patients between June 1, 2005, and June 30, 2009. Antimicrobial approval was the outcome of interest. We assessed gaming by studying trends in automatically approved requests. Nonparametric tests for trend were performed to detect changes in approval patterns. Multiple logistic regression was used to identify factors associated with approval.
The vast majority (91.3%) of antimicrobial requests were approved, with an increase of 6.1% over time (P < .01). Renewal requests were more likely than primary requests (adjusted odds ratio [aOR], 1.72; 95% confidence interval [CI], 1.45-2.04) to be approved. Antiviral requests had higher odds of approval than antibiotic requests (aOR, 1.27; 95% CI, 1.04-1.56). Compared with requests by medical services, requests by surgical services had lower odds of approval (aOR, 0.70; 95% CI, 0.59-0.83), whereas pediatric intensive care requests had higher odds of approval (aOR, 1.18; 95% CI, 1.00-1.40). The number of auto-approved requests remained consistent.
The Web-based ASP allows management of a large number of antimicrobial requests, without apparent gaming. Observed differences in approval patterns based on patient, requestor, and antimicrobial factors may inform the development of ASPs and evaluation of provider education and training.
约翰霍普金斯儿童医疗与手术中心于 2005 年开发了一个基于网络的抗菌药物管理计划（ASP）。本研究旨在评估该 ASP 的纵向抗菌药物申请和批准模式。
我们分析了 2005 年 6 月 1 日至 2009 年 6 月 30 日期间 3542 名患者共 16229 次抗菌药物申请。抗菌药物的批准是我们关注的结果。我们通过研究自动批准请求的趋势来评估博弈行为。使用非参数趋势检验来检测批准模式的变化。使用多因素逻辑回归来确定与批准相关的因素。
绝大多数（91.3%）抗菌药物申请获得批准，随着时间的推移，批准率增加了 6.1%（P<.01）。与首次申请相比，续用申请的批准率更高（调整优势比[aOR]，1.72；95%置信区间[CI]，1.45-2.04）。抗病毒药物的申请比抗生素药物的申请更有可能获得批准（aOR，1.27；95% CI，1.04-1.56）。与医疗服务申请相比，手术服务申请的批准率较低（aOR，0.70；95% CI，0.59-0.83），而儿科重症监护申请的批准率较高（aOR，1.18；95% CI，1.00-1.40）。自动批准请求的数量保持不变。
基于网络的 ASP 可管理大量抗菌药物申请，且无明显博弈行为。基于患者、请求者和抗菌药物因素的批准模式差异可能为 ASP 的开发以及对提供者教育和培训的评估提供信息。
