接受血液透析患者抗生素的使用模式及合理性：一项观察性研究。
Patterns of use and appropriateness of antibiotics prescribed to patients receiving haemodialysis: an observational study.
作者信息
Hui Katrina, Nalder Michelle, Buising Kirsty, Pefanis Aspasia, Ooi Khai Y, Pedagogos Eugenie, Nelson Craig, Kirkpatrick Carl M J, Kong David C M
机构信息
Centre for Medicine Use and Safety, Monash University, Melbourne, Australia.
Department of Pharmacy, Royal Melbourne Hospital, Melbourne, Australia.
出版信息
BMC Nephrol. 2017 May 12;18(1):156. doi: 10.1186/s12882-017-0575-9.
BACKGROUND
There are limited published data on the types and appropriateness of oral and intravenous (IV) antibiotics prescribed to patients receiving haemodialysis. This information is critical to optimise antibiotic prescribing. Therefore this study aims to describe the patterns of use and the appropriateness of oral and IV antibiotics prescribed to patients receiving haemodialysis.
METHODS
This was a prospective, observational study across four community and two hospital inpatient haemodialysis units in Melbourne, Australia. Data were collected from July 2014 to January 2015 from participants. Antibiotic regimens prescribed were compared with nationally available antibiotic guidelines and then classified as being either appropriate, inappropriate or not assessable by an expert multidisciplinary team using the National Antimicrobial Prescribing Survey tool.
RESULTS
Overall, 114 participants consented to this study where 55.3% (63/114) received antibiotics and 235 antibiotic regimens were prescribed at a rate of 69.1 antibiotic regimens/100 patient-months. The most common oral antibiotics prescribed were amoxycillin/clavulanic acid and cephalexin. The most common IV antibiotics prescribed were vancomycin, piperacillin/tazobactam, cephazolin and ceftriaxone. The percentage of inappropriate antibiotic regimens prescribed were 34.9% (15/43) in the community setting and 22.1% (40/181) in the hospital setting. Furthermore, 29.4% (30/102) of oral and 20.5% (25/122) of IV antibiotic regimens were inappropriate with incorrect dosing as the primary reason.
CONCLUSION
Although this study is limited by the sample size, it describes the high antibiotic exposure that patients receiving haemodialysis experience. Of concern is inappropriate dose and frequency being a major issue. This requires interventions focused on the quality use of medicines and antimicrobial stewardship aspects of prescribing in this population.
背景
关于接受血液透析患者口服和静脉注射抗生素的类型及合理性，已发表的数据有限。这些信息对于优化抗生素处方至关重要。因此，本研究旨在描述接受血液透析患者口服和静脉注射抗生素的使用模式及合理性。
方法
这是一项在澳大利亚墨尔本的四个社区和两个医院住院血液透析单元开展的前瞻性观察性研究。2014年7月至2015年1月收集了参与者的数据。将所开具的抗生素治疗方案与全国可用的抗生素指南进行比较，然后由一个专家多学科团队使用国家抗菌药物处方调查工具将其分类为适当、不适当或不可评估。
结果
总体而言，114名参与者同意参与本研究，其中55.3%（63/114）接受了抗生素治疗，共开具了235种抗生素治疗方案，开具率为69.1种抗生素治疗方案/100患者月。最常用的口服抗生素是阿莫西林/克拉维酸和头孢氨苄。最常用的静脉注射抗生素是万古霉素、哌拉西林/他唑巴坦、头孢唑林和头孢曲松。在社区环境中，不适当抗生素治疗方案的比例为34.9%（15/43），在医院环境中为22.1%（40/181）。此外，口服抗生素治疗方案中有29.4%（30/102）、静脉注射抗生素治疗方案中有20.5%（25/122）不适当，主要原因是给药剂量错误。
结论
尽管本研究受样本量限制，但它描述了接受血液透析患者的高抗生素暴露情况。令人担忧的是，剂量和频率不当是一个主要问题。这需要针对该人群药物合理使用和处方抗菌管理方面进行干预。
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