传染病领域的“明智选择”倡议。
The "Choosing Wisely" initiative in infectious diseases.
作者信息
Lehmann Clara, Berner Reinhard, Bogner Johannes R, Cornely Oliver A, de With Katja, Herold Susanne, Kern Winfried V, Lemmen Sebastian, Pletz Mathias W, Ruf Bernhard, Salzberger Bernd, Stellbrink Hans Jürgen, Suttorp Norbert, Ullmann Andrew J, Fätkenheuer Gerd, Jung Norma
机构信息
Department I of Internal Medicine, University of Cologne, Cologne, Germany.
German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
出版信息
Infection. 2017 Jun;45(3):263-268. doi: 10.1007/s15010-017-0997-0. Epub 2017 Mar 13.
OBJECTIVE
"Choosing Wisely" is a growing international campaign aiming at practice changes to improve patient health and safety by both, conduct of essential and avoidance of unnecessary diagnostic, preventive and therapeutic procedures. The goal is to create an easily recognizable and distributable list ("Choosing Wisely items") that addresses common over- and underuse in the management of infectious diseases.
METHODS
The German Society of Infectious Diseases (DGI) participates in the campaign "Klug Entscheiden" by the German Society of Internal Medicine. Committee members of the (DGI) listed potential 'Choosing Wisely items'. Topics were subjected to systematic evidence review and top ten items were selected for appropriateness. Five positive and negative recommendations were approved via individual member vote.
RESULTS
The final recommendations are: (1) Imperatively start antimicrobial treatment and remove the focus in Staphylococcus aureus bloodstream infection. (2) Critically ill patients with signs of infection need early appropriate antibiotic therapy. (3) Annual influenza vaccination should be given to individuals with age >60 years, patients with specific co-morbidities and to contact persons who may spread influenza to others. (4) All children should receive measles vaccine. (5) Prefer oral formulations of highly bioavailable antimicrobials whenever possible. (6) Avoid prescribing antibiotics for uncomplicated upper respiratory tract infections. (7) Do not treat asymptomatic bacteriuria with antibiotics. (8) Do not treat Candida detected in respiratory or gastrointestinal tract specimens. (9) Do not prolong prophylactic administration of antibiotics in patients after they have left the operating room. (10) Do not treat an elevated C-reactive protein (CRP) or procalcitonin with antibiotics for patients without signs of infection.
CONCLUSIONS
Physicians will reduce potential harm to patients and increase the value of health care when implementing these recommendations.
目的
“明智选择”是一项日益壮大的国际运动，旨在通过实施必要的措施以及避免不必要的诊断、预防和治疗程序来改变医疗行为，以改善患者的健康与安全。目标是创建一份易于识别和传播的清单（“明智选择条目”），以解决传染病管理中常见的过度医疗和医疗不足问题。
方法
德国传染病学会（DGI）参与了德国内科医学学会发起的“明智决策”运动。DGI的委员会成员列出了潜在的“明智选择条目”。对这些主题进行了系统的证据审查，并选出了十条最合适的条目。通过个人成员投票批准了五条正面和五条负面建议。
结果
最终建议如下：（1）对于金黄色葡萄球菌血流感染，必须开始抗菌治疗并去除感染源。（2）有感染迹象的重症患者需要早期给予适当的抗生素治疗。（3）年龄>60岁的个体、患有特定合并症的患者以及可能将流感传播给他人的接触者应每年接种流感疫苗。（4）所有儿童都应接种麻疹疫苗。（5）尽可能优先选择高生物利用度抗菌药物的口服制剂。（6）避免为单纯性上呼吸道感染开具抗生素。（7）不要用抗生素治疗无症状菌尿。（8）不要治疗在呼吸道或胃肠道标本中检测到的念珠菌。（9）患者离开手术室后，不要延长抗生素的预防性使用时间。（10）对于没有感染迹象的患者，不要用抗生素治疗C反应蛋白（CRP）或降钙素原升高的情况。
结论
医生在实施这些建议时将减少对患者的潜在危害，并提高医疗保健的价值。
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