Division of Infectious Diseases, Department of Internal Medicine, The Brody School of Medicine at East Carolina University, Doctor's Park 6A, Mail Stop 715, Greenville, NC, 27834, USA.
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, East Carolina University, Brody School of Medicine, Greenville, NC, 27834, USA.
Infection. 2017 Oct;45(5):645-649. doi: 10.1007/s15010-017-1047-7. Epub 2017 Jul 19.
We previously demonstrated the benefit of direct, daily collaboration between infectious disease (ID) and critical care practitioners (CCP) on guideline adherence and antibiotic use in the medical intensive care unit (MICU). In this post-intervention review, we sought to establish whether the effect on antibiotic use and guideline adherence was sustainable.
A retrospective review of 87 patients, admitted to the 24-bed MICU, was done 3 (n = 45) and 6 months (n = 42) after the intervention.
Data included demographics, severity indicators, admitting pathology, infectious diagnosis, clinical outcomes [mechanical ventilation days (MVD) and MICU length of stay (LOS), antibiotic days of therapy (DOT), in-hospital mortality], and antibiotic appropriateness based on current guidelines.
In the 3-month (3-PI) and 6-month post-intervention (6-PI), there were no significant differences in the APACHE II score, MVD, LOS, DOT, or total antibiotic use at 3 (p = 0.59) and 6-PI (p = 0.87). There was no change in the mean use of extended-spectrum penicillins, cephalosporin, and carbapenems. While there were significant differences in vancomycin usage at 3-PI [3.1 DOT vs. 4.3 DOT (p = 0.007)], this finding was not seen after 6 months [3.1 DOT vs. 3.4 DOT (p = 0.08)]. When compared to the intervention period, the inappropriateness of antibiotic use at 3 (p = 1.00) and 6-PI (p = 0.30) did not change significantly.
There were no significant differences in either total antibiotic use or inappropriate antibiotic use at the 6-PI time period. Continuous, daily, direct collaboration between ID and CCP, once implemented, can have lasting effects even at 6 months after the interaction has been discontinued.
我们之前已经证明了传染病（ID）和重症监护医生（CCP）之间直接、日常合作对医疗重症监护病房（MICU）中指南遵循和抗生素使用的益处。在这项干预后评估中，我们试图确定对抗生素使用和指南遵循的影响是否可持续。
回顾性分析了 87 名入住 24 张床位的 MICU 的患者，在干预后 3 个月（n=45）和 6 个月（n=42）进行了评估。
数据包括人口统计学、严重程度指标、入院病理、感染诊断、临床结局[机械通气天数（MVD）和 MICU 住院时间（LOS）、抗生素治疗天数（DOT）、院内死亡率]以及根据当前指南确定的抗生素适当性。
在 3 个月（3-PI）和 6 个月（6-PI）后干预期间，APACHE II 评分、MVD、LOS、DOT 或 3 个月（p=0.59）和 6 个月（p=0.87）时的总抗生素使用均无显著差异。扩展谱青霉素、头孢菌素和碳青霉烯类抗生素的平均使用量没有变化。虽然万古霉素的使用在 3-PI 时有显著差异[3.1 DOT 与 4.3 DOT（p=0.007）]，但 6 个月后未见差异[3.1 DOT 与 3.4 DOT（p=0.08）]。与干预期相比，3 个月（p=1.00）和 6 个月（p=0.30）时抗生素使用的不适当性无显著变化。
在 6-PI 时间段，总抗生素使用或不适当抗生素使用均无显著差异。传染病医生和重症监护医生之间的持续、日常、直接合作，一旦实施，即使在互动停止 6 个月后，也可能产生持久影响。
