Chou Ann F, Graber Christopher J, Jones Makoto, Zhang Yue, Goetz Matthew Bidwell, Madaras-Kelly Karl, Samore Matthew, Kelly Allison, Glassman Peter A
1Department of Health Administration and Policy,College of Public Health,University of Oklahoma,Oklahoma City,Oklahoma.
4David Geffen School of Medicine at University of California-Los Angeles (UCLA),Los Angeles,California.
Infect Control Hosp Epidemiol. 2016 Jun;37(6):647-54. doi: 10.1017/ice.2016.26. Epub 2016 Feb 24.
BACKGROUND Antimicrobial stewardship programs (ASPs) are variably implemented. OBJECTIVE To characterize variations of antimicrobial stewardship structure and practices across all inpatient Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage. DESIGN A web-based survey regarding stewardship activities was administered to each facility's designated contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012 were determined. SETTING Total of 130 Veterans Affairs facilities with inpatient services. RESULTS Of 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]), stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96 [74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03), an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration were associated with increased use (P=.03). CONCLUSIONS ASP-related activities varied considerably. Decreased antibiotic use appeared related to ID presence and certain select practices. Further statistical assessments may help optimize antimicrobial practices. Infect Control Hosp Epidemiol 2016;37:647-654.
背景 抗菌药物管理计划（ASP）的实施情况各不相同。目的 描述2012年所有退伍军人事务部住院设施中抗菌药物管理结构和实践的差异，并将关键特征与抗菌药物使用情况相关联。设计 针对每个设施的指定联系人进行了一项关于管理活动的网络调查。确定了2012年设施特征与住院患者抗菌药物使用之间的双变量关联。场所 共有130个提供住院服务的退伍军人事务部设施。结果 在130个回复的设施中，29个（22%）有建立ASP的正式政策，12个（9%）有批准的ASP商业计划。49个设施（38%）有抗菌药物管理团队；34个团队包括一名经过正式传染病（ID）培训的临床药师。各设施的管理活动各不相同，包括制定年度抗菌谱（122个[94%]）、处方限制（120个[92%]）、抗菌药物使用期限的停用医嘱（98个[75%]）以及针对特定病症的书面临床路径（96个[74%]）。抗菌药物使用减少与至少有1名全职ID医师（P = 0.03）、ID专科培训项目（P = 0.003）、经过正式ID培训的临床药师（P = 0.006）以及系统的患者层面抗菌药物使用审查频率（P = 0.01）和有在艰难梭菌感染背景下处理抗菌药物使用的政策（P = 0.01）相关。抗菌药物使用期限的停用医嘱与使用增加相关（P = 0.03）。结论 与ASP相关的活动差异很大。抗生素使用减少似乎与ID人员的存在和某些特定做法有关。进一步的统计评估可能有助于优化抗菌药物实践。《感染控制与医院流行病学》2016年；37：647 - 654。
