Akhloufi H, Hulscher M, Melles D C, Prins J M, van der Sijs H, Verbon A
Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
Department of Internal Medicine, Division of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
J Antimicrob Chemother. 2017 Feb;72(2):543-546. doi: 10.1093/jac/dkw470. Epub 2016 Dec 20.
Despite huge overlap in suggested criteria for a safe intravenous (iv)-to-oral antibiotic switch, there is considerable variation in their operationalization. The objective of this study was to develop a set of measurable conditions that should be met in adult hospitalized patients for a safe iv-to-oral switch.
A RAND-modified Delphi procedure was performed to develop a set of operationalized iv-to-oral switch criteria. Switch criteria and their accompanying suggested measurable conditions were extracted from the literature and appraised by a multidisciplinary expert panel during two questionnaire rounds with a face-to-face meeting between these two rounds. In a final step, the experts could approve the set of developed operationalized switch criteria.
Seven switch criteria and 41 accompanying measurable conditions extracted from the literature were appraised. Sixteen measurable conditions that operationalize six switch criteria were selected: (i) stable systolic blood pressure; and the absence of (ii) fever, (iii) temperature <36°C, (iv) malabsorption syndrome, (v) short bowel syndrome, (vi) severe gastroparesis, (vii) ileus, (viii) continuous nasogastric suction, (ix) vomiting, (x) (severe) sepsis, (xi) fasciitis necroticans, (xii) CNS infection, (xiii) Staphylococcus aureus bacteraemia, and (xiv) endovascular infection. In addition, (xv) the patient should be cooperative and (xvi) adequate antimicrobial concentration should be achievable at the site of infection by oral administration.
These operationalized criteria can be used in daily clinical practice. Future use of these criteria in audits and as rules in clinical decision support systems will facilitate the performance and evaluation of iv-oral switch programmes.
尽管在建议的安全静脉转口服抗生素切换标准方面存在大量重叠，但在其实施过程中仍存在很大差异。本研究的目的是制定一套适用于成年住院患者安全静脉转口服切换应满足的可衡量条件。
采用兰德改良德尔菲法制定一套可实施的静脉转口服切换标准。从文献中提取切换标准及其附带的建议可衡量条件，并由多学科专家小组在两轮问卷调查中进行评估，两轮调查之间有一次面对面会议。在最后一步，专家们可以批准这套制定好的可实施切换标准。
对从文献中提取的7条切换标准和41条附带的可衡量条件进行了评估。选择了16条可衡量条件来实施6条切换标准：（i）收缩压稳定；且不存在（ii）发热、（iii）体温<36°C、（iv）吸收不良综合征、（v）短肠综合征、（vi）严重胃轻瘫、（vii）肠梗阻、（viii）持续鼻胃管吸引、（ix）呕吐、（x）（严重）脓毒症、（xi）坏死性筋膜炎、（xii）中枢神经系统感染、（xiii）金黄色葡萄球菌菌血症和（xiv）血管内感染。此外，（xv）患者应配合，且（xvi）口服给药应能在感染部位达到足够的抗菌浓度。
这些可实施的标准可用于日常临床实践。未来在审核中使用这些标准以及将其作为临床决策支持系统中的规则，将有助于静脉转口服切换方案的实施和评估。
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