Furuno Jon P, Comer Angela C, Johnson J Kristie, Rosenberg Joseph H, Moore Susan L, MacKenzie Thomas D, Hall Kendall K, Hirshon Jon Mark
Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland, Oregon.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S56-61. doi: 10.1086/677818.
Antibiograms have effectively improved antibiotic prescribing in acute-care settings; however, their effectiveness in skilled nursing facilities (SNFs) is currently unknown.
To develop SNF-specific antibiograms and identify opportunities to improve antibiotic prescribing.
Cross-sectional and pretest-posttest study among residents of 3 Maryland SNFs.
Antibiograms were created using clinical culture data from a 6-month period in each SNF. We also used admission clinical culture data from the acute care facility primarily associated with each SNF for transferred residents. We manually collected all data from medical charts, and antibiograms were created using WHONET software. We then used a pretest-posttest study to evaluate the effectiveness of an antibiogram on changing antibiotic prescribing practices in a single SNF. Appropriate empirical antibiotic therapy was defined as an empirical antibiotic choice that sufficiently covered the infecting organism, considering antibiotic susceptibilities.
We reviewed 839 patient charts from SNF and acute care facilities. During the initial assessment period, 85% of initial antibiotic use in the SNFs was empirical, and thus only 15% of initial antibiotics were based on culture results. Fluoroquinolones were the most frequently used empirical antibiotics, accounting for 54.5% of initial prescribing instances. Among patients with available culture data, only 35% of empirical antibiotic prescribing was determined to be appropriate. In the single SNF in which we evaluated antibiogram effectiveness, prevalence of appropriate antibiotic prescribing increased from 32% to 45% after antibiogram implementation; however, this was not statistically significant ([Formula: see text]).
Implementation of antibiograms may be effective in improving empirical antibiotic prescribing in SNFs.
抗菌谱已有效改善了急性护理环境中的抗生素处方；然而，其在熟练护理机构（SNFs）中的有效性目前尚不清楚。
制定特定于SNFs的抗菌谱，并确定改善抗生素处方的机会。
对马里兰州3家SNFs的居民进行横断面和预测试-后测试研究。
使用每个SNF中6个月期间的临床培养数据创建抗菌谱。我们还使用了主要与每个SNF相关的急性护理机构为转院居民提供的入院临床培养数据。我们从病历中手动收集所有数据，并使用WHONET软件创建抗菌谱。然后，我们进行了一项预测试-后测试研究，以评估抗菌谱对改变单个SNF中抗生素处方实践的有效性。考虑到抗生素敏感性，适当的经验性抗生素治疗被定义为足以覆盖感染病原体的经验性抗生素选择。
我们审查了来自SNF和急性护理机构的839份患者病历。在初始评估期间，SNFs中85%的初始抗生素使用是经验性的，因此只有15%的初始抗生素是基于培养结果。氟喹诺酮类是最常用的经验性抗生素，占初始处方实例的54.5%。在有可用培养数据的患者中，只有35%的经验性抗生素处方被确定为适当。在我们评估抗菌谱有效性的单个SNF中，抗菌谱实施后适当抗生素处方的患病率从32%增加到45%；然而，这在统计学上并不显著（[公式：见正文]）。
实施抗菌谱可能有效地改善SNFs中的经验性抗生素处方。
