澳大利亚一家三级医疗中心抗菌药物过敏及药物不良反应的患病率与影响
The prevalence and impact of antimicrobial allergies and adverse drug reactions at an Australian tertiary centre.
作者信息
Trubiano Jason A, Cairns Kelly A, Evans Jacqui A, Ding Amally, Nguyen Tuan, Dooley Michael J, Cheng Allen C
机构信息
Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia.
Department of Infectious Diseases, Austin Health, Melbourne, VIC, Australia.
出版信息
BMC Infect Dis. 2015 Dec 16;15:572. doi: 10.1186/s12879-015-1303-3.
BACKGROUND
The prevalence and impact of antimicrobial "allergy" labels and Adverse Drug Reactions (ADRs) on antibiotic usage and antimicrobial stewardship initiatives is ill defined. We sought to examine the rate of antimicrobial "allergy labels" at our tertiary referral centre and impacts on antimicrobial usage and appropriateness.
METHODS
Two inpatient antimicrobial prevalence surveys were conducted over a 1-week period in November 2013 and 2014 as part of the prospective National Antimicrobial Prescribing Survey (NAPS). Post survey, patients recorded in the NAPS database were assigned to two groups based upon recorded antimicrobial "allergy label" and ADR: (i) Antimicrobial Allergy/ADR (AA) or (ii) No Antimicrobial Allergy/ADR (NAA). Antimicrobial usage and antimicrobial appropriateness were compared between AA and NAA groups.
RESULTS
From 509 identified patients the prevalence of an antimicrobial allergy or ADR was 25 %. The prevalence of "allergy labels"/ADR was 10 % (51/509) for penicillin V/G, 5 % (24/509) cephalosporins, 4 % (22/509) trimethroprim-sulfamethoxazole and 3 % (17/509) aminopenicillins. One thousand and seventy antimicrobials were prescribed during the study periods, the median antimicrobial duration was longer in the AA versus NAA group (6 days vs. 4 days; p = 0.018), and proportion of inappropriate antimicrobial prescribing higher in the AA group compared with NAA (29 %; 35/120 vs. 23 %; 86/367, p = 0.22). Oral antimicrobial administration was higher in the NAA than AA group (60 %; 177/297 vs. 46 %; 356/793, p = 0.0001). The proportion of patients that received a β-lactam was lower in the AA versus NAA group (60 % vs. 79 %, p = 0.0001).
CONCLUSIONS
In an Australian tertiary referral centre an antimicrobial "allergy" or ADR label was found to significantly impacted on rate of oral antimicrobial administration, beta-lactam usage, antimicrobial duration and antimicrobial appropriateness.
背景
抗菌药物“过敏”标签及药物不良反应（ADR）对抗生素使用和抗菌药物管理措施的影响尚不明确。我们试图在我们的三级转诊中心研究抗菌药物“过敏标签”的发生率及其对抗菌药物使用和合理性的影响。
方法
作为前瞻性全国抗菌药物处方调查（NAPS）的一部分，于2013年11月和2014年进行了为期1周的两次住院患者抗菌药物使用率调查。调查后，根据记录的抗菌药物“过敏标签”和ADR，将NAPS数据库中记录的患者分为两组：（i）抗菌药物过敏/ADR（AA）组或（ii）无抗菌药物过敏/ADR（NAA）组。比较AA组和NAA组的抗菌药物使用情况及抗菌药物使用合理性。
结果
在509名确定的患者中，抗菌药物过敏或ADR的发生率为25%。青霉素V/G的“过敏标签”/ADR发生率为10%（51/509），头孢菌素为5%（24/509），甲氧苄啶-磺胺甲恶唑为4%（22/509），氨基青霉素为3%（17/509）。在研究期间共开具了1070剂抗菌药物，AA组的抗菌药物使用中位数时间长于NAA组（6天对4天；p = 0.018），AA组抗菌药物不合理处方的比例高于NAA组（29%；35/120对23%；86/367，p = 0.22）。NAA组口服抗菌药物的使用率高于AA组（60%；177/297对46%；356/793，p = 0.0001）。AA组接受β-内酰胺类药物治疗的患者比例低于NAA组（60%对79%，p = 0.0001）。
结论
在澳大利亚一家三级转诊中心，发现抗菌药物“过敏”或ADR标签对口服抗菌药物使用率、β-内酰胺类药物使用、抗菌药物使用时间及抗菌药物使用合理性有显著影响。
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