Department of Pharmacy, Sunnybrook Health Sciences Centre.
Department of Pharmacy, Sunnybrook Health Sciences Centre Leslie L. Dan Faculty of Pharmacy, University of Toronto Department of Microbiology and Division of Infectious Diseases, Sunnybrook Health Sciences Centre.
Clin Infect Dis. 2014 Sep 15;59(6):867-74. doi: 10.1093/cid/ciu445. Epub 2014 Jun 13.
Our objective was to rigorously evaluate the impact of an antimicrobial stewardship audit-and-feedback intervention, via a stepped-wedge randomized trial. An effective intensive care unit (ICU) audit-and-feedback program was rolled out to 6 non-ICU services in a randomized sequence. The primary outcome was targeted antimicrobial utilization, using a negative binomial regression model to assess the impact of the intervention while accounting for secular and seasonal trends. The intervention was successfully transitioned, with high volumes of orders reviewed, suggestions made, and recommendations accepted. Among patients meeting stewardship review criteria, the intervention was associated with a large reduction in targeted antimicrobial utilization (-21%, P = .004); however, there was no significant change in targeted antibiotic use among all admitted patients (-1.2%, P = .9), and no reductions in overall costs and microbiologic outcomes. An ICU day 3 audit-and-feedback program can be successfully expanded hospital-wide, but broader benefits on non-ICU wards may require interventions earlier in the course of treatment.
我们的目标是通过一项逐步随机试验，严格评估抗菌药物管理审核和反馈干预的影响。一项有效的重症监护病房（ICU）审核和反馈计划以随机顺序推广到 6 个非 ICU 服务。主要结局指标是目标抗菌药物的使用情况，使用负二项回归模型评估干预措施的影响，同时考虑到季节性和季节性趋势。该干预措施成功过渡，审查了大量订单，提出了建议，并接受了建议。在符合管理审查标准的患者中，该干预措施与目标抗菌药物使用量的大幅减少（-21%，P=0.004）相关；然而，所有入院患者的目标抗生素使用量没有显著变化（-1.2%，P=0.9），总费用和微生物学结果也没有降低。ICU 第 3 天的审核和反馈计划可以在全院范围内成功推广，但在非 ICU 病房中获得更广泛的益处可能需要在治疗早期进行干预。
