Elsan Group, Rue de la Boétie, Paris.
Faculty of Medicine, University of Nice Sophia-Antipolis, France.
Clin Infect Dis. 2019 Jul 18;69(3):466-472. doi: 10.1093/cid/ciy921.
Assessment of antimicrobial use places an emphasis on therapeutic aspects of infected patients. Our aim was to determine the risk factors for unnecessary antibiotic therapy (UAT).
This was a prospective, multicenter study evaluating all curative antibiotic therapies prescribed over 2 consecutive days through the same electronic medical records. Each item that could participate in these prescriptions was collected from the computerized file (reason for hospitalization, comorbid conditions, suspected or definitive diagnosis of infection, microbial analyses). UAT was defined as the recognition of noninfectious sydromes (NIS), nonbacterial infections, use of redundant antimicrobials, and continuation of empirical broad-spectrum antimicrobials.
Four hundred fifty-three antibiotic therapies were analyzed at 17 institutions. An infectious disease was the reason for hospitalization in 201 cases (44%). An unspecified diagnosis of infection was observed in 104 cases (23%). Microbial samples were taken in 296 cases (65%), allowing isolation of a pathogen in 156 cases (53%). Unspecified diagnosis was associated with the absence of a microbial sample compared to patients with a diagnosis: (56/104 [54%] vs 240/349 [69%]; P = .005). A total of 158 NIS were observed (35%). UAT was observed in 169 cases (37%), due to NIS in 106 cases. In multivariate analysis, the modifiable risk factors for UAT were unspecified diagnosis (adjusted odds ratio [AOR], 1.83; 95% confidence interval [CI], 1.04-3.20) and absence of a blood culture (AOR, 5.26; 95% CI, 2.56-10.00).
UAT is associated with an unspecified diagnosis and the absence of microbial testing. Antimicrobial stewardship programs should focus on diagnostic difficulties and microbial testing, the latter facilitating antibiotic reassessment and therapeutic interruption.
抗菌药物使用评估侧重于感染患者的治疗方面。我们的目的是确定不必要的抗生素治疗（UAT）的危险因素。
这是一项前瞻性、多中心研究，通过相同的电子病历评估连续两天内开出的所有治愈性抗生素治疗。从计算机文件中收集可能参与这些处方的每个项目（住院原因、合并症、感染疑似或明确诊断、微生物分析）。UAT 定义为识别非感染性综合征（NIS）、非细菌性感染、使用冗余抗菌药物以及继续使用经验性广谱抗菌药物。
在 17 家机构分析了 453 种抗生素治疗。传染病是 201 例（44%）住院的原因。104 例（23%）诊断为感染不明。采集了 296 例微生物样本（65%），其中 156 例（53%）分离出病原体。与有诊断的患者相比，未明确诊断与未采集微生物样本相关：（56/104 [54%] 比 240/349 [69%]；P=0.005）。共观察到 158 例 NIS（35%）。由于 NIS，观察到 169 例（37%）UAT，其中 106 例。多变量分析显示，UAT 的可改变危险因素为未明确诊断（调整后的优势比 [AOR]，1.83；95%置信区间 [CI]，1.04-3.20）和未进行血培养（AOR，5.26；95%CI，2.56-10.00）。
UAT 与未明确诊断和缺乏微生物检测有关。抗菌药物管理计划应重点关注诊断困难和微生物检测，后者有助于对抗生素重新评估和治疗中断。
