Kreitmeyr Katharina, von Both Ulrich, Pecar Alenka, Borde Johannes P, Mikolajczyk Rafael, Huebner Johannes
Division of Pediatric Infectious Diseases, Dr. von Hauner Children's Hospital, LMU Munich, Munich, Germany.
Department of Pharmacy, University Hospital, LMU Munich, Munich, Germany.
Infection. 2017 Aug;45(4):493-504. doi: 10.1007/s15010-017-1009-0. Epub 2017 Apr 10.
Antibiotic stewardship programs (ASP) optimize antibiotic usage and combat antibiotic resistance of bacteria. The objective of this study was to assess the impact of specific ASP interventions on antibiotic consumption in general pediatric wards.
We conducted a prospective study to compare a pre-intervention (Sept.-Dec. 2014) and post-intervention (Sept.-Dec. 2015) period. An ASP bundle was established including (1) infectious diseases (ID) ward rounds (prospective-audit-with-feedback), (2) ID consultation service, (3) internal guidelines on empiric antibiotic therapy. Medical records on four general pediatric wards were reviewed daily to analyze: (1) antibiotic consumption, (2) antibiotic dosage ranges according to local guidelines, and (3) guideline adherence for community-acquired pneumonia (CAP).
Antibiotic prescribing for 273 patients (pre-intervention) was compared to 263 patients (post-intervention). Antibiotic prescription rate did not change (30.6 vs. 30.5%). However, overall days-of-therapy and length-of-therapy decreased by 10.5 and 7.7%, respectively. Use of cephalosporins and fluoroquinolones decreased by 35.5 and 59.9%, whereas the use of penicillins increased by 15.0%. An increase in dosage accuracy was noted (78.8 vs. 97.6%) and guideline adherence for CAP improved from 39.5 to 93.5%. Between the two study periods, no adverse effects regarding length of hospital stay and in-hospital mortality were observed.
Our data demonstrate that implementation of an ASP was associated with a profound improvement of rational antibiotic use and, therefore, patient safety. Considering the relatively short observation period, the long-term effects of our ASP bundle need to be further investigated.
抗生素管理计划（ASP）可优化抗生素使用并对抗细菌的抗生素耐药性。本研究的目的是评估特定ASP干预措施对普通儿科病房抗生素消耗的影响。
我们进行了一项前瞻性研究，比较干预前（2014年9月至12月）和干预后（2015年9月至12月）两个时期。建立了一个ASP综合措施，包括（1）传染病（ID）病房查房（前瞻性审核并反馈），（2）ID咨询服务，（3）经验性抗生素治疗的内部指南。每天查阅四个普通儿科病房的病历，以分析：（1）抗生素消耗情况，（2）根据当地指南的抗生素剂量范围，以及（3）社区获得性肺炎（CAP）的指南依从性。
将273例患者（干预前）的抗生素处方与263例患者（干预后）的进行比较。抗生素处方率没有变化（30.6%对30.5%）。然而，总的治疗天数和治疗时长分别减少了10.5%和7.7%。头孢菌素和氟喹诺酮类药物的使用分别减少了35.5%和59.9%，而青霉素的使用增加了15.0%。注意到剂量准确性有所提高（78.8%对97.6%），CAP的指南依从性从39.5%提高到了93.5%。在两个研究期间，未观察到与住院时长和住院死亡率相关的不良影响。
我们的数据表明，实施ASP与合理使用抗生素以及患者安全的显著改善相关。考虑到观察期相对较短，我们的ASP综合措施的长期效果需要进一步研究。
