Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
Am J Infect Control. 2017 Oct 1;45(10):1091-1100. doi: 10.1016/j.ajic.2017.04.005. Epub 2017 Jun 8.
Although integrated, electronic sepsis screening and treatment protocols are thought to improve patient outcomes, less is known about their unintended consequences. We aimed to determine if the introduction of a sepsis initiative coincided with increases in broad-spectrum antibiotic use and health care facility-onset (HCFO) Clostridium difficile infection (CDI) rates.
We used interrupted time series data from a large, tertiary, urban academic medical center including all adult inpatients on 4 medicine wards (June 2011-July 2014). The main exposure was implementation of the sepsis screening program; the main outcomes were the use of broad-spectrum antibiotics (including 3 that were part of an order set designed for the sepsis initiative) and HCFO CDI rates. Segmented regression analyses compared outcomes in 3 time segments: before (11 months), during (14 months), and after (12 months) implementation of a sepsis initiative.
Antibiotic use and HFCO CDI rates increased during the period of implementation and the period after implementation compared with baseline; these increases were highest in the period after implementation (level change, 50.4 days of therapy per 1,000 patient days for overall antibiotic use and 10.8 HCFO CDIs per 10,000 patient days; P < .05). Remarkably, the main drivers of overall antibiotic use were not those included in the sepsis order set.
The implementation of an electronic sepsis screening and treatment protocol coincided with increased broad-spectrum antibiotic use and HCFO CDIs. Because these protocols are increasingly used, further study of their unintended consequences is warranted.
虽然集成的电子脓毒症筛查和治疗方案被认为可以改善患者的预后，但人们对其不良后果知之甚少。我们旨在确定脓毒症计划的引入是否与广谱抗生素使用和医疗机构获得性（HCFO）艰难梭菌感染（CDI）率的增加有关。
我们使用了来自一家大型三级城市学术医疗中心的大型中断时间序列数据，其中包括 4 个内科病房的所有成年住院患者（2011 年 6 月至 2014 年 7 月）。主要暴露是脓毒症筛查计划的实施；主要结果是广谱抗生素的使用（包括 3 种用于脓毒症计划的订单集设计的抗生素）和 HCFO CDI 率。分段回归分析比较了 3 个时间段的结果：实施前（11 个月）、实施期间（14 个月）和实施后（12 个月）。
与基线相比，在实施期间和实施后期间，抗生素的使用和 HFCO CDI 率增加；在实施后期间增加幅度最高（总抗生素使用的治疗天数变化为每 1000 名患者 50.4 天，每 10000 名患者 10.8 例 HCFO CDI；P < 0.05）。值得注意的是，总抗生素使用的主要驱动因素不是脓毒症订单集中包含的那些。
电子脓毒症筛查和治疗方案的实施与广谱抗生素使用和 HCFO CDI 的增加有关。由于这些方案越来越多地被使用，因此需要进一步研究它们的不良后果。
