Goodlet Kellie J, Nailor Michael D
Department of Pharmacy, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
Department of Pharmacy, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA; University of Connecticut School of Pharmacy, 69 North Eagleville Road, Unit 3092, Storrs, CT 06269, USA.
Diagn Microbiol Infect Dis. 2017 May;88(1):41-46. doi: 10.1016/j.diagmicrobio.2017.02.013. Epub 2017 Feb 27.
Preauthorization strategies, including restricting broad-spectrum antimicrobials such as carbapenems to infectious diseases physicians (ID) are commonly employed by stewardship programs. The appropriateness, or "necessity" of empiric carbapenem therapy by ID, defined as an isolated organism sensitive to the carbapenem and resistant to cefepime, was evaluated over a 6month span and included 84 patients. Additionally, 30 patients followed by ID who were not prescribed a carbapenem until final susceptibilities were included as a definitive therapy group. Differences in multi-drug resistant organism (MDRO) risk factors between groups were non-significant. Carbapenem therapy was necessary for only 6 (7%) empiric therapy patients, while four times as many definitive group patients required a carbapenem but did not receive one empirically. Overall, ID's ability to accurately gauge which patients required carbapenems appeared poor in this study. Alternative risk stratification strategies may better guide broad-spectrum antimicrobial use than ID judgment alone.
管理计划通常采用预授权策略，包括将碳青霉烯类等广谱抗菌药物的使用限制于传染病医生（ID）。在6个月的时间跨度内，对传染病医生进行经验性碳青霉烯治疗的适当性或“必要性”进行了评估，该评估将经验性碳青霉烯治疗定义为分离出的一种对碳青霉烯敏感但对头孢吡肟耐药的微生物，研究共纳入了84例患者。此外，30例由传染病医生随访的患者，在最终药敏结果出来之前未使用碳青霉烯类药物，这些患者被纳入确定性治疗组。两组之间多重耐药菌（MDRO）危险因素的差异无统计学意义。在经验性治疗的患者中，仅6例（7%）需要碳青霉烯治疗，而在确定性治疗组中，需要碳青霉烯治疗但未接受经验性治疗的患者数量是前者的四倍。总体而言，在本研究中，传染病医生准确判断哪些患者需要使用碳青霉烯类药物的能力似乎较差。与仅依靠传染病医生的判断相比，替代风险分层策略可能能更好地指导广谱抗菌药物的使用。
