Lowe Christopher F, Payne Michael, Puddicombe David, Mah Allison, Wong Davie, Kirkwood Allison, Hull Mark W, Leung Victor
Division of Microbiology and Virology, Providence Health Care, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Infection Prevention and Control, Providence Health Care, Vancouver, BC, Canada.
Division of Microbiology and Virology, Providence Health Care, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Infection Prevention and Control, Providence Health Care, Vancouver, BC, Canada.
Am J Infect Control. 2017 Aug 1;45(8):872-875. doi: 10.1016/j.ajic.2017.03.025. Epub 2017 May 16.
The purpose of this study was to implement a targeted antimicrobial stewardship intervention for patients with a viral respiratory tract infection.
This was a quasi-experimental before and after audit and feedback intervention of adult inpatients with a positive polymerase chain reaction for a respiratory virus in 2 acute care hospitals in Vancouver, Canada. Audit and feedback was implemented based on 2 criteria: microbiology (no positive bacterial cultures) and chest imaging (absence of pneumonia or consolidation on radiology dictation). A chart review was conducted to assess for days of antibiotics postviral diagnosis. Outcomes including length of stay, intensive care unit admission within 14 days, mechanical ventilation within 14 days, antibiotics prescribed within 14 days, Clostridium difficile infection diagnosed within 30 days, and readmission within 30 days were also reviewed in comparison with the previous year.
Antimicrobial stewardship recommendations for hospitalized patients with viral respiratory tract infections were accepted for 77% of cases. This targeted approach based on easily assessed parameters translated into a 1.3-day (95% confidence interval, 0.3-2.3; P < .01) decrease in mean days of antibiotics postviral diagnosis compared with the previous year without systematic interventions. Compared with the previous year, no differences were identified for adverse outcomes associated with the intervention.
A targeted antimicrobial stewardship intervention integrating virology testing with the treating physician facilitated a reduction in duration of antibiotic treatment for viral respiratory tract infections.
本研究的目的是对病毒呼吸道感染患者实施有针对性的抗菌药物管理干预措施。
这是一项在加拿大温哥华的2家急症医院对成人住院患者进行的准实验性前后审计及反馈干预研究，这些患者呼吸道病毒聚合酶链反应检测呈阳性。审计及反馈基于2项标准实施：微生物学（无阳性细菌培养结果）和胸部影像学（放射学报告中无肺炎或实变）。进行图表审查以评估病毒诊断后使用抗生素的天数。还与上一年进行比较，审查了包括住院时间、14天内入住重症监护病房、14天内机械通气、14天内开具的抗生素、30天内诊断出的艰难梭菌感染以及30天内再入院等结果。
住院病毒呼吸道感染患者的抗菌药物管理建议在77%的病例中被采纳。与上一年未进行系统干预相比，这种基于易于评估参数的针对性方法使病毒诊断后抗生素平均使用天数减少了1.3天（95%置信区间，0.3 - 2.3；P < 0.01）。与上一年相比，未发现与干预相关的不良后果有差异。
将病毒学检测与治疗医生相结合的有针对性的抗菌药物管理干预措施有助于减少病毒呼吸道感染的抗生素治疗时长。
