Høgli June Utnes, Garcia Beate Hennie, Skjold Frode, Skogen Vegard, Småbrekke Lars
Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, N - 9037, Tromsø, Norway.
Department of Infectious Diseases, Division of Internal Medicine, University Hospital of North Norway, N - 9038, Tromsø, Norway.
BMC Infect Dis. 2016 Feb 27;16:96. doi: 10.1186/s12879-016-1426-1.
Appropriate antibiotic prescribing is associated with favourable levels of antimicrobial resistance (AMR) and clinical outcomes. Most intervention studies on antibiotic prescribing originate from settings with high level of AMR. In a Norwegian hospital setting with low level of AMR, the literature on interventions for promoting guideline-recommended antibiotic prescribing in hospital is scarce and requested. Preliminary studies have shown improvement potentials regarding antibiotic prescribing according to guidelines. We aimed to promote appropriate antibiotic prescribing in patients with community-acquired pneumonia (CAP) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) at a respiratory medicine department in a Norwegian University hospital. Our specific objectives were to increase prescribing of appropriate empirical antibiotics, reduce high-dose benzylpenicillin and reduce total treatment duration.
We performed an audit and feedback intervention study, combined with distribution of a recently published pocket version of the national clinical practice guideline. We included patients discharged with CAP or AECOPD and prescribed antibiotics during hospital stay, and excluded those presenting with aspiration, nosocomial infection and co-infections. The pre- and post-intervention period was 9 and 6 months, respectively. Feedback was provided orally to the department physicians at an internal-educational meeting. To explore the effect of the intervention on appropriate empirical antibiotics and mean total treatment duration we applied before-after analysis (Student's t-test) and interrupted time series (ITS). We used Pearson's χ2 to compare dose changes.
In the pre-and post-intervention period we included 253 and 155 patients, respectively. Following the intervention, overall mean prescribing of appropriate empirical antibiotics increased from 61.7 to 83.8 % (P < 0.001), overall mean total treatment duration decreased from 11.2 to 10.4 days (P = 0.015), and prescribing of high-dose benzylpenicillin decreased from 48.8 to 38.6 % (P = 0.125). With ITS we found that six months post-intervention, the effect on appropriate empirical antibiotic prescribing had increased and sustained, while the effect on treatment duration was at pre-intervention level.
The combination of audit and feedback plus distribution of a pocket version of guideline recommendations led to a substantial increase in prescribing of appropriate empirical antibiotics, which is important due to favourable effect on AMR and clinical outcomes.
合理使用抗生素与良好的抗菌药物耐药性（AMR）水平及临床疗效相关。大多数关于抗生素处方的干预研究都来自于AMR水平较高的环境。在挪威一家AMR水平较低的医院环境中，关于促进医院遵循指南推荐使用抗生素的干预措施的文献稀缺且有需求。初步研究表明，在遵循指南使用抗生素方面存在改善潜力。我们旨在促进挪威一家大学医院呼吸内科社区获得性肺炎（CAP）和慢性阻塞性肺疾病急性加重（AECOPD）患者的合理抗生素处方。我们的具体目标是增加适当经验性抗生素的处方量，减少大剂量苄星青霉素的使用，并缩短总治疗时长。
我们进行了一项审核与反馈干预研究，并结合分发最近出版的国家临床实践指南袖珍版。我们纳入了因CAP或AECOPD出院且住院期间使用了抗生素的患者，并排除了有吸入性肺炎、医院感染和合并感染的患者。干预前和干预后的时间段分别为9个月和6个月。在一次内部教育会议上向科室医生进行了口头反馈。为了探究干预对适当经验性抗生素和平均总治疗时长的影响，我们应用了前后分析（学生t检验）和中断时间序列（ITS）。我们使用Pearson卡方检验来比较剂量变化。
在干预前和干预后阶段，我们分别纳入了253例和155例患者。干预后，适当经验性抗生素的总体平均处方量从61.7%增加到83.8%（P < 0.001），总体平均总治疗时长从11.2天降至10.4天（P = 0.015），大剂量苄星青霉素的处方量从48.8%降至38.6%（P = 0.125）。通过ITS我们发现，干预后六个月，对适当经验性抗生素处方的影响有所增加且持续存在，而对治疗时长的影响则处于干预前水平。
审核与反馈以及分发指南推荐袖珍版的结合，导致适当经验性抗生素的处方量大幅增加，这因对AMR和临床疗效有良好影响而很重要。
