抗菌药物管理团队的干预措施对血流感染患者临床病程及经济结局的影响。
Effect of interventions by an antimicrobial stewardship team on clinical course and economic outcome in patients with bloodstream infection.
作者信息
Maeda Masayuki, Takuma Takahiro, Seki Haruka, Ugajin Kazuhisa, Naito Yuika, Yoshikawa Masayuki, Yamanaka Ayumi, Oto Yuji, Minemura Atsuko, Shoji Hisashi, Ishino Keiko, Niki Yoshihito
机构信息
Division of Infection Control Sciences, Department of Pharmacotherapeutics, School of Pharmacy, Showa University, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
出版信息
J Infect Chemother. 2016 Feb;22(2):90-5. doi: 10.1016/j.jiac.2015.11.004. Epub 2015 Dec 10.
BACKGROUND
Bloodstream infections (BSIs) represent one of the most severe and clinically important conditions in the hospital setting. We have organized an interdisciplinary antimicrobial stewardship team (AST) at our hospital and performed consultations focusing on BSI patients since 2013. This study aimed to evaluate the impact of AST interventions on the diagnosis, treatment, and clinical outcomes of BSI patients.
METHODS
We conducted a retrospective quasi-experimental study of BSI patients at a single Japanese university hospital. AST provided recommendations to attending physicians regarding appropriate diagnosis, therapy, and management of BSI patients after reviewing medical charts.
RESULTS
We identified a total of 308 cases of BSI from January to December, 2012 (pre-intervention group) and 324 cases of BSI from April, 2013 to March, 2014 (post-intervention group). No significant differences in the in-hospital mortality or 30-day mortality rates were observed between both the groups. Inappropriate therapy was initiated in a significantly lower proportion of patients in the post-intervention group (18.5% vs. 11.4%; P = 0.012). Multivariate analysis confirmed that inappropriate therapy was significantly associated with in-hospital mortality (odds ratio, 2.62; 95% confidence interval, 1.42-4.82; P = 0.002).
CONCLUSIONS
An interdisciplinary AST intervention approach decreases the use of inappropriate therapy and may improve clinical outcomes in BSI patients.
背景
血流感染（BSIs）是医院环境中最严重且临床上最重要的病症之一。自2013年以来，我们在我院组建了一个跨学科抗菌药物管理团队（AST），并针对血流感染患者进行会诊。本研究旨在评估AST干预对血流感染患者的诊断、治疗及临床结局的影响。
方法
我们在一家日本大学医院对血流感染患者进行了一项回顾性准实验研究。AST在查阅病历后就血流感染患者的适当诊断、治疗及管理向主治医师提供建议。
结果
我们共确定了2012年1月至12月的308例血流感染病例（干预前组）以及2013年4月至2014年3月的324例血流感染病例（干预后组）。两组之间在院内死亡率或30天死亡率方面未观察到显著差异。干预后组中开始不适当治疗的患者比例显著更低（18.5%对11.4%；P = 0.012）。多变量分析证实，不适当治疗与院内死亡率显著相关（比值比，2.62；95%置信区间，1.42 - 4.82；P = 0.002）。
结论
跨学科AST干预方法可减少不适当治疗的使用，并可能改善血流感染患者的临床结局。
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