VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, UT 84148, USA Division of Epidemiology, University of Utah, Salt Lake City, UT 84132, USA.
VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, UT 84148, USA Division of Epidemiology, University of Utah, Salt Lake City, UT 84132, USA
J Antimicrob Chemother. 2015 Feb;70(2):598-601. doi: 10.1093/jac/dku388. Epub 2014 Oct 6.
To assess rates of starting or stopping antibiotics across different hospitals.
We used barcode medication administration data to measure antibiotic use on acute-care wards in 128 Veterans Affairs medical centres (VAMCs) in 2010. A treatment day (TD) was defined as the administration of any antibiotic on a given day. A treatment period (TP) was defined as an interval of inpatient antimicrobial therapy with gaps of ≤1 day in TDs. The rate of starting antibiotics was calculated for inpatients who had not yet started antibiotics, as the number of start events divided by the 'person-time at risk'. The rate of stopping antibiotics was calculated analogously for inpatients that were on antibiotics. Once individuals had stopped antibiotics they were removed from further analysis. Per-day start and stop rates were also calculated for each day of hospitalization.
The hospital mean rate of starting the first TP was 18.1 start events/100 days at risk (range 8.4-25.6/100 days at risk). The mean hospital stopping rate was 21.1 stop events/100 days at risk (range 13.3-29.5/100 days at risk). The ratio of a facility's starting and stopping rates was highly correlated with overall antibiotic use in TDs/1000 patient-days (rs=0.92, P<0.001), while starting and stopping rates individually were only moderately correlated (rs=0.39, P<0.001).
VAMCs with similar antibiotic use showed marked differences in their starting and stopping rates of antibiotics. It may be useful to target empirical therapy when starting rates are high and definitive therapy when stopping rates are low.
评估不同医院开始或停止使用抗生素的比率。
我们使用条码药物管理数据，来衡量 2010 年在 128 个退伍军人事务医疗中心（VAMC）的急性护理病房中抗生素的使用情况。治疗日（TD）定义为在某一天给予任何抗生素。治疗期（TP）定义为在 TD 中抗生素治疗间隔≤1 天的住院抗菌治疗。对于尚未开始使用抗生素的住院患者，开始使用抗生素的比率是将开始事件的数量除以“风险人群的时间”。对于正在使用抗生素的住院患者，抗生素停止使用的比率是通过类似的方法计算的。一旦患者停止使用抗生素，他们将被从进一步的分析中移除。每天的开始和停止率也根据住院的每一天计算。
医院开始第一个 TP 的平均比率为 18.1 个开始事件/100 天风险（范围为 8.4-25.6/100 天风险）。医院平均停止率为 21.1 个停止事件/100 天风险（范围为 13.3-29.5/100 天风险）。设施的开始和停止比率的比值与 TD/1000 患者天的抗生素总使用量高度相关（rs=0.92，P<0.001），而开始和停止比率本身仅中度相关（rs=0.39，P<0.001）。
具有相似抗生素使用量的 VAMC 在开始和停止抗生素使用方面表现出显著差异。当开始率较高时，开始经验性治疗可能是有用的，而当停止率较低时，开始确定性治疗可能是有用的。
