University Health Network, Toronto, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; St Michael's Hospital Li Ka Shing Centre for Healthcare Analytics Research and Training, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada.
Clin Microbiol Infect. 2018 Aug;24(8):882-888. doi: 10.1016/j.cmi.2017.11.009. Epub 2017 Nov 11.
To examine the effectiveness of an antimicrobial stewardship programme on utilization and cost of antimicrobials in leukaemia patients in Canada.
We conducted a multisite retrospective observational time series study from 2005 to 2013. We implemented academic detailing as the intervention of an antimicrobial stewardship programme in leukaemia units at a hospital, piloted February-July 2010, then fully implemented December 2010-March 2013, with no intervention in August-November 2010. Internal control was the same hospital's allogeneic haematopoietic stem-cell transplantation unit. External control was the combined leukaemia-haematopoietic stem-cell transplantation unit at another hospital. Primary outcome was antimicrobial utilization (antibiotics and antifungals) in defined daily dose per 100 patient-days (PD). Secondary outcomes were antimicrobial cost (Canadian dollars per PD); cost and utilization by drug class; length of stay; 30-day inpatient mortality; and nosocomial Clostridium difficile infection. We used autoregressive integrated moving average models to evaluate the impact of the intervention on outcomes.
The intervention group included 1006 patients before implementation and 335 during full implementation. Correspondingly, internal control had 723 and 264 patients, external control 1395 and 864 patients. Antimicrobial utilization decreased significantly in the intervention group (p <0.01, 278 vs. 247 defined daily dose per 100 PD), increased in external control (p = 0.02, 237.4 vs. 268.9 defined daily dose per 100 PD) and remained stable in internal control (p = 0.66). Antimicrobial cost decreased in the intervention group (p = 0.03; $154.59 per PD vs. $128.93 per PD), increased in external control (p = 0.01; $109.4 per PD vs. $135.97 per PD) but was stable in internal control (p = 0.27). Mortality, length of stay and nosocomial C. difficile rate in intervention group remained stable.
The antimicrobial stewardship programme reduced antimicrobial use in leukaemia patients without affecting inpatient mortality and length of stay.
考察在加拿大白血病患者中实施抗菌药物管理计划对抗菌药物利用和成本的影响。
我们进行了一项多地点回顾性时间序列研究，研究时间为 2005 年至 2013 年。我们在一家医院的白血病病房实施了以学术指导为干预措施的抗菌药物管理计划，该计划于 2010 年 2 月至 7 月试行，然后于 2010 年 12 月至 2013 年 3 月全面实施，2010 年 8 月至 11 月则无干预措施。内部对照为同一家医院的异基因造血干细胞移植病房。外部对照为另一家医院的白血病-造血干细胞移植联合病房。主要结局指标为每 100 个患者日（PD）的抗菌药物使用量（抗生素和抗真菌药物），以定义日剂量（DDD）表示。次要结局指标为抗菌药物成本（每 PD 加元）；药物类别成本和使用量；住院时间；30 天住院死亡率；以及医院获得性艰难梭菌感染。我们使用自回归综合移动平均模型来评估干预措施对结果的影响。
干预组在实施前纳入了 1006 例患者，实施后纳入了 335 例患者。相应地，内部对照分别纳入了 723 例和 264 例患者，外部对照分别纳入了 1395 例和 864 例患者。干预组的抗菌药物使用量显著下降（p<0.01，278 比 247 DDD/100 PD），外部对照组上升（p=0.02，237.4 比 268.9 DDD/100 PD），内部对照组则保持稳定（p=0.66）。干预组的抗菌药物成本下降（p=0.03；每 PD 154.59 加元比每 PD 128.93 加元），外部对照组上升（p=0.01；每 PD 109.4 加元比每 PD 135.97 加元），但内部对照组保持稳定（p=0.27）。干预组的死亡率、住院时间和医院获得性艰难梭菌感染率保持稳定。
抗菌药物管理计划减少了白血病患者的抗菌药物使用量，同时不影响住院死亡率和住院时间。
