Dumkow Lisa E, Axford Katie L, Suda K J, Draper Heather M, Brandt Kasey L
Department of Pharmaceutical Services, Mercy Health Saint Mary's, 200 Jefferson SE, Grand Rapids, MI 49503, USA.
Department of Pharmaceutical Services, Mercy Health Saint Mary's, 200 Jefferson SE, Grand Rapids, MI 49503, USA; Ferris State University College of Pharmacy, 220 Ferris Drive, Big Rapids, MI, 49307, USA.
Diagn Microbiol Infect Dis. 2018 Oct;92(2):136-142. doi: 10.1016/j.diagmicrobio.2018.05.014. Epub 2018 May 28.
A culture follow-up program with an emphasis on symptom assessment may limit antibiotic exposure in patients with Group A Streptococcus on throat culture. A quasi-experimental study of such patients was conducted in our Emergency Department and Urgent Care centers. During the prestewardship initiative phase (March 2011-June 2012), the standard of care for culture follow-up did not include symptom assessment prior to prescribing antibiotics. During the stewardship initiative phase (March 2015-June 2016), culture follow-up was completed with a focus on symptom assessment and antibiotic avoidance. Two-hundred eighty patients were included. Antibiotic prescribing at follow-up decreased from 97.0% to 71.3% (P < 0.001); overall appropriateness of therapy at follow-up, including symptom assessment, increased from 6.0% to 81.5% (P < 0.001). There was no difference in 72-h revisit between the pre- and poststewardship initiative groups (P = 0.121). This study demonstrated improved antimicrobial prescribing with initiation of a stewardship-focused culture follow-up program in the Emergency Department and Urgent Care centers.
一项着重于症状评估的培养物随访计划可能会减少A组链球菌咽培养阳性患者的抗生素暴露。我们在急诊科和紧急护理中心对这类患者进行了一项准实验研究。在开展管理措施之前的阶段（2011年3月至2012年6月），培养物随访的护理标准不包括在开抗生素之前进行症状评估。在开展管理措施阶段（2015年3月至2016年6月），培养物随访的重点是症状评估和避免使用抗生素。纳入了280名患者。随访时抗生素处方率从97.0%降至71.3%（P<0.001）；随访时包括症状评估在内的总体治疗适宜性从6.0%增至81.5%（P<0.001）。开展管理措施前后两组的72小时复诊率无差异（P=0.121）。这项研究表明，在急诊科和紧急护理中心启动以管理为重点的培养物随访计划可改善抗菌药物处方情况。
