Population Health Sciences, School of Medicine, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK.
Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, West Nile Street, Glasgow G1 2NP, UK.
J Antimicrob Chemother. 2018 Feb 1;73(2):517-526. doi: 10.1093/jac/dkx413.
Antimicrobial exposure is associated with increased risk of Clostridium difficile infection (CDI), but the impact of prescribing interventions on CDI and other outcomes is less clear.
To evaluate the effect of an antimicrobial stewardship intervention targeting high-risk antimicrobials (HRA), implemented in October 2008, and to compare the findings with similar studies from a systematic review.
All patients admitted to Medicine and Surgery in Ninewells Hospital from October 2006 to September 2010 were included. Intervention effects on HRA use (dispensed DDD), CDI cases and mortality rates, per 1000 admissions per month, were analysed separately in Medicine and Surgery using segmented regression of interrupted time series (ITS) data. Data from comparable published studies were reanalysed using the same method.
Six months post-intervention, there were relative reductions in HRA use of 33% (95% CI 11-56) in Medicine and 32% (95% CI 19-46) in Surgery. At 12 months, there was an estimated reduction in CDI of 7.0 cases/1000 admissions [relative change -24% (95% CI - 55 to 6)] in Medicine, but no change in Surgery {estimated 0.1 fewer cases/1000 admissions [-2% (95% CI - 116 to 112)]}. Mortality reduced throughout the study period, unaffected by the intervention. In all six comparable studies, HRA use reduced significantly, but reductions in CDI rates were only statistically significant in two and none measured mortality. Pre-intervention CDI rates and trends influenced the intervention effect.
Despite large reductions in HRA prescribing and reductions in CDI, demonstrating real-world impact of stewardship interventions remains challenging.
抗菌药物的使用与艰难梭菌感染（CDI）的风险增加有关，但针对高风险抗菌药物（HRA）的药物管理干预对 CDI 和其他结果的影响尚不清楚。
评估 2008 年 10 月实施的针对高风险抗菌药物（HRA）的抗菌药物管理干预的效果，并将研究结果与系统评价中的类似研究进行比较。
纳入 2006 年 10 月至 2010 年 9 月期间入住 Ninewells 医院内科和外科的所有患者。使用分段回归的时间序列（ITS）数据分别对内科和外科的 HRA 使用（处方 DDD）、CDI 病例数和死亡率进行分析，每月每 1000 例患者进行分析。使用相同的方法重新分析了来自类似已发表研究的数据。
干预后 6 个月，内科 HRA 使用量相对减少 33%（95%CI 11-56），外科 HRA 使用量相对减少 32%（95%CI 19-46）。12 个月时，内科 CDI 估计减少 7.0 例/1000 例患者（相对变化-24%（95%CI -55 至 6）），而外科无变化{估计减少 0.1 例/1000 例患者[-2%（95%CI -116 至 112）]}。整个研究期间，死亡率均降低，不受干预影响。在所有六项类似研究中，HRA 使用量均显著减少，但只有两项研究中 CDI 发生率的减少具有统计学意义，而没有研究测量死亡率。干预前 CDI 发生率和趋势影响了干预效果。
尽管 HRA 处方大量减少，CDI 减少，但仍难以证明药物管理干预的实际效果。
