Kelly Allison A, Jones Makoto M, Echevarria Kelly L, Kralovic Stephen M, Samore Matthew H, Goetz Matthew B, Madaras-Kelly Karl J, Simbartl Loretta A, Morreale Anthony P, Neuhauser Melinda M, Roselle Gary A
1National Infectious Diseases Service,Veterans Health Administration,Washington,DC.
4IDEAS Center,Salt Lake City Veterans Affairs Medical Center,Salt Lake City,Utah.
Infect Control Hosp Epidemiol. 2017 May;38(5):513-520. doi: 10.1017/ice.2016.328. Epub 2017 Jan 25.
OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513-520.
目的 详细介绍退伍军人健康管理局（VHA）抗菌药物管理倡议的活动，并评估该计划的成果。设计 观察性分析。背景 VHA是一个大型综合医疗系统，每年在140多个医疗设施中为约600万人提供服务。方法 报告全国范围内开发的资源利用情况、抗生素的比例分布、管理措施的变化以及患者安全措施。此外，还评估了全国性管理活动实施前后的住院患者抗菌药物使用情况。结果 全国范围内开发的管理资源得到了充分利用，许多管理措施显著增加，包括到2015年92%的医疗机构制定了书面管理政策（P<0.05）。虽然抗生素的比例分布没有变化，但VHA抗菌药物管理倡议活动开始后，住院患者抗生素使用量显著下降（P<0.0001）。总体抗生素使用量下降了12%。VHA还注意到，用于耐革兰氏阴性菌（包括碳青霉烯类）的抗菌药物使用量显著下降，同时医院再入院率和死亡率也在下降。与此同时，VHA报告艰难梭菌感染率下降。结论 VHA国家抗菌药物管理倡议除其他高度利用的资源外，还包括继续教育、针对特定疾病的指南以及示例政策的制定。虽然尚未确定抗菌药物使用的具体理想水平，但VHA表明，通过国家指导和资源以及在当地实施抗菌药物管理计划，可以在大型医疗系统中改善抗菌药物的使用。《感染控制与医院流行病学》2017年；38:513 - 520。
