Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah.
Division of Infectious Diseases, Stanford University School of Medicine, California.
Clin Infect Dis. 2018 Aug 1;67(4):525-532. doi: 10.1093/cid/ciy155.
Studies on the implementation of antibiotic stewardship programs (ASPs) in small hospitals are limited. Accreditation organizations now require all hospitals to have ASPs.
The objective of this cluster-randomized intervention was to assess the effectiveness of implementing ASPs in Intermountain Healthcare's 15 small hospitals. Each hospital was randomized to 1 of 3 ASPs of escalating intensity. Program 1 hospitals were provided basic antibiotic stewardship education and tools, access to an infectious disease hotline, and antibiotic utilization data. Program 2 hospitals received those interventions plus advanced education, audit and feedback for select antibiotics, and locally controlled antibiotic restrictions. Program 3 hospitals received program 2 interventions plus audit and feedback on the majority of antibiotics, and an infectious diseases-trained clinician approved restricted antibiotics and reviewed microbiology results. Changes in total and broad-spectrum antibiotic use within programs (intervention versus baseline) and the difference between programs in the magnitude of change in antibiotic use (eg, program 3 vs 1) were evaluated with mixed models.
Program 3 hospitals showed reductions in total (rate ratio, 0.89; confidence interval, .80-.99) and broad-spectrum (0.76; .63-.91) antibiotic use when the intervention period was compared with the baseline period. Program 1 and 2 hospitals did not experience a reduction in antibiotic use. Comparison of the magnitude of effects between programs showed a similar trend favoring program 3, but this was not statistically significant.
Only the most intensive ASP intervention was associated with reduction in total and broad-spectrum antibiotic use when compared with baseline.
NCT03245879.
针对小型医院抗生素管理计划（ASPs）实施情况的研究有限。目前，认证机构要求所有医院都必须建立 ASP。
本项集群随机干预研究旨在评估在爱默生医疗保健公司的 15 家小型医院中实施 ASP 的效果。每家医院随机分为 3 组 ASP 干预组之一，每组干预强度逐渐增加。第 1 组医院接受基本的抗生素管理教育和工具、传染病热线、抗生素使用数据。第 2 组在此基础上增加了高级教育、针对特定抗生素的审核和反馈、以及局部控制抗生素限制。第 3 组在第 2 组的基础上增加了对大多数抗生素的审核和反馈、以及一名接受过传染病培训的临床医生批准限制使用的抗生素并审核微生物学结果。通过混合模型评估各方案内（干预期与基线期）总抗生素和广谱抗生素使用的变化，以及方案间抗生素使用变化幅度的差异（例如，第 3 组与第 1 组）。
与基线期相比，第 3 组医院的总抗生素（比率比，0.89；置信区间，0.80-0.99）和广谱抗生素（0.76；0.63-0.91）使用率均有所下降。第 1 组和第 2 组医院未出现抗生素使用率下降的情况。方案间效果幅度的比较显示，第 3 组方案具有相似的优势，但未达到统计学显著差异。
与基线相比，只有最强化的 ASP 干预与总抗生素和广谱抗生素使用率的降低相关。
NCT03245879。
