在门诊透析单位实施抗菌药物管理计划。
Implementing an antimicrobial stewardship program in out-patient dialysis units.
作者信息
Cunha Cheston B, D'Agata Erika M C
机构信息
Division of Infectious Diseases, Brown University, Warren Alpert Medical School, Providence, Rhode Island, USA.
出版信息
Curr Opin Nephrol Hypertens. 2016 Nov;25(6):551-555. doi: 10.1097/MNH.0000000000000281.
PURPOSE OF REVIEW
Rates of multidrug-resistant organisms (MDRO), including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and multidrug-resistant gram-negative bacteria, continue to rise among the population of chronic hemodialysis. Antimicrobial exposure is the main risk factor for MDRO emergence and dissemination. Up to 30% of antimicrobial doses administered in out-patient dialysis units may not be indicated. Antimicrobial stewardship programs (ASP) improve antimicrobial prescribing patterns. The purpose of this review is to highlight the key elements and interventions of ASP.
RECENT FINDINGS
The Infectious Disease Society of America and the Society of Healthcare Epidemiology of America have provided evidence-based guidelines for the development and implementation of an ASP. Many of their recommendations can be adapted to the out-patient dialysis setting.
SUMMARY
Developing and implementing an ASP by following key elements and interventions in the out-patient dialysis setting can lead to reduced mortality, adverse events, costs, and improvement in antimicrobial susceptibility rates.
综述目的
在慢性血液透析人群中，包括耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌和多重耐药革兰氏阴性菌在内的多重耐药菌（MDRO）的发生率持续上升。抗菌药物暴露是MDRO出现和传播的主要危险因素。门诊透析单位高达30%的抗菌药物剂量可能并不必要。抗菌药物管理计划（ASP）可改善抗菌药物的处方模式。本综述的目的是强调ASP的关键要素和干预措施。
最新发现
美国传染病学会和美国医疗保健流行病学学会为ASP的制定和实施提供了循证指南。它们的许多建议可适用于门诊透析环境。
总结
在门诊透析环境中遵循关键要素和干预措施来制定和实施ASP，可降低死亡率、不良事件、成本，并提高抗菌药物敏感性。
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