Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow, Scotland.
Regional Infectious Diseases Unit, Western General Hospital, Crewe Road, Edinburgh, Scotland.
J Antimicrob Chemother. 2018 Aug 1;73(8):2223-2230. doi: 10.1093/jac/dky171.
Concern about increasing carbapenem and piperacillin/tazobactam use led the Scottish Antimicrobial Prescribing Group (SAPG) to develop national guidance on optimal use of these agents, and to implement a quality improvement programme to assess the impact of guidance on practice.
To evaluate how SAPG guidance had been implemented by health boards, assess how this translated into clinical practice, and investigate clinicians' views and behaviours about prescribing carbapenems and alternative agents.
Local implementation of SAPG guidance was assessed using an online survey. A bespoke point prevalence survey was used to evaluate prescribing. Clinicians' experience of using carbapenems and alternatives was examined through semi-structured interviews. National prescribing data were analysed to assess the impact of the programme.
There were greater local restrictions for carbapenems than for piperacillin/tazobactam. Laboratory result suppression was inconsistent between boards and carbapenem-sparing antibiotics were not widely available. Compliance with local guidelines was good for meropenem but lower for piperacillin/tazobactam. Indication for use was well documented but review/stop dates were poorly documented for both antibiotics. Decisions to prescribe a carbapenem were influenced by local guidelines and specialist advice. Many clinicians lacked confidence to de-escalate treatment. Use of both antibiotics decreased during the course of the programme.
A multifaceted quality improvement programme was used to gather intelligence, promote behaviour change, and focus interventions on the use of carbapenems and piperacillin/tazobactam. Use of these antimicrobials decreased during the programme-a trend not seen elsewhere in Europe. The programme could be generalized to other antimicrobials.
由于担心碳青霉烯类和哌拉西林/他唑巴坦类药物的使用量不断增加，苏格兰抗菌药物处方组（SAPG）制定了关于这些药物合理使用的国家指南，并实施了一项质量改进计划，以评估指南对实践的影响。
评估卫生委员会对 SAPG 指南的实施情况，评估其对临床实践的影响，并调查临床医生在碳青霉烯类和替代药物处方方面的看法和行为。
通过在线调查评估 SAPG 指南的本地实施情况。使用专门的点患病率调查来评估处方。通过半结构化访谈来研究临床医生使用碳青霉烯类和替代药物的经验。分析国家处方数据以评估该计划的影响。
与哌拉西林/他唑巴坦类药物相比，碳青霉烯类药物的本地限制更大。各委员会之间的实验室结果抑制不一致，且碳青霉烯类节约型抗生素的供应并不广泛。本地指南对美罗培南的遵守情况良好，但对哌拉西林/他唑巴坦类药物的遵守情况较差。使用这两种抗生素的适应症都有详细记录，但对两者的复查/停药日期的记录都很差。使用碳青霉烯类药物的决定受到本地指南和专家建议的影响。许多临床医生缺乏降低治疗强度的信心。在该计划实施过程中，这两种抗生素的使用均有所减少。
采用了多方面的质量改进计划，以收集情报、促进行为改变，并将干预重点放在碳青霉烯类和哌拉西林/他唑巴坦类药物的使用上。在该计划实施期间，这两种抗生素的使用减少了——这一趋势在欧洲其他地方并未出现。该计划可以推广到其他抗生素。
