Unité de Contrôle, Epidémiologie et Prévention de l'Infection, Université Paris EST Créteil, Groupe Hospitalier Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil.
Département d'Epidémiologie et Recherche Clinique, Hôpital Bichat, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, UMR 1123; and INSERM, CIC-EC 1425, Paris.
Clin Microbiol Infect. 2015 Feb;21(2):180.e1-7. doi: 10.1016/j.cmi.2014.08.015. Epub 2014 Oct 14.
Although review of antibiotic therapy is recommended to optimize antibiotic use, physicians do not always perform it. This trial aimed to evaluate the impact of a systematic postprescription review performed by antimicrobial stewardship program (ASP) infectious disease physicians (IDP) on the quality of in-hospital antibiotic use. A multicenter, prospective, randomized, parallel-group trial using the PROBE (Prospective Randomized Open-label Blinded Endpoint) methodology was conducted in eight surgical or medical wards of four hospitals. Two hundred forty-six patients receiving antibiotic therapy prescribed by ward physicians for less than 24 hours were randomized to receive either a systematic review by the ASP IDP at day 1 and days 3 to 4 (intervention group, n = 123) or no systematic review (usual care, n = 123). The primary outcome measure was appropriateness of antimicrobial therapy, a composite score of appropriateness of antibiotic use at days 3 to 4 and appropriate treatment duration, adjudicated by a blinded committee. Analyses were performed on an intention-to-treat basis. In the intervention group, appropriateness of antimicrobial therapy was more frequent (55/123, 44.7% vs. 35/123, 28.5%; odds ratio 2.03, 95% confidence interval 1.20-3.45). Antibiotic treatment duration was lower in the intervention group (median (interquartile range) 7 (3-9) days vs. 10 (7-12) days; p 0.003). ASP IDP counseling to change therapy was more frequent at days 3 to 4 than at day 1 (114/123; 92.7% vs. 24/123; 19.5%, p <0.001). Clinical outcome was similar between groups. This study suggests that a systematic postprescription antibiotic review performed at days 1 and 3 to 4 results in higher quality of antibiotic use and lower antibiotic duration. This trial was registered at ClinicalTrials.gov (NCT01136200).
尽管建议对抗生素治疗进行审查以优化抗生素的使用，但医生并非总是如此。这项试验旨在评估抗菌药物管理计划（ASP）传染病医生（IDP）进行系统的处方后审查对住院期间抗生素使用质量的影响。采用 PROBE（前瞻性随机开放标签盲终点）方法进行了一项多中心、前瞻性、随机、平行组试验，在四家医院的八个外科或内科病房进行。将 246 名接受病房医生开具的抗生素治疗且治疗时间少于 24 小时的患者随机分为接受 ASP IDP 在第 1 天和第 3 至 4 天进行系统审查的干预组（n=123）或不进行系统审查的常规护理组（n=123）。主要观察指标是抗菌治疗的适当性，这是一个在第 3 至 4 天和适当治疗持续时间评估抗生素使用适当性的综合评分，由一个盲法委员会裁决。分析采用意向治疗。在干预组中，抗菌治疗的适当性更常见（55/123，44.7% vs. 35/123，28.5%；比值比 2.03，95%置信区间 1.20-3.45）。干预组的抗生素治疗持续时间较短（中位数（四分位间距）7（3-9）天 vs. 10（7-12）天；p<0.003）。在第 3 至 4 天比第 1 天，ASP IDP 更频繁地建议改变治疗方案（114/123；92.7% vs. 24/123；19.5%，p<0.001）。两组之间的临床结局相似。这项研究表明，在第 1 天和第 3 至 4 天进行系统的处方后抗生素审查可提高抗生素使用质量并缩短抗生素治疗时间。这项试验在 ClinicalTrials.gov 上注册（NCT01136200）。
