Wijnakker Roos, Visser Loes E, Schippers Emile F, Visser Leo G, van Burgel Nathalie D, van Nieuwkoop Cees
Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Department of Hospital Pharmacy, Haga Teaching Hospital, The Hague, The Netherlands.
Int J Clin Pharm. 2019 Feb;41(1):49-55. doi: 10.1007/s11096-018-0751-4. Epub 2018 Nov 26.
Background There is increasing interest in outpatient parenteral antimicrobial treatment. Objective To evaluate the added value of consultation of an infectious diseases expert team (consisting of two internist-infectious diseases specialists and a microbiologist) for advice regarding type, administration route and duration of antibiotic treatment. Setting A retrospective case series was performed at the Haga Teaching Hospital, a 700-bed regional teaching hospital in The Hague, The Netherlands. Methods Complication rate and mortality was evaluated during 60 days of follow-up. Therapeutic rationality regarding outpatient parenteral antimicrobial treatment was determined by presenting randomly selected paper cases from the database to two independent infectious diseases specialists who were blinded to patient's treatment and outcomes. The concordance between the two advices were analysed using Cohen's kappa. For those with discordance, an infectious diseases expert team meeting was organized to reach consensus. The final recommendation was compared to the actual given antibiotic treatment. Main outcome measure Discrepancy between the infectious disease expert team recommendations upon type, administration route and duration of antibiotics and the real outpatient parenteral antimicrobial treatment practice. Results Out of 89 included cases, 50 were randomly selected for review by the infectious diseases specialists. The kappa statistic regarding antimicrobial policy was 0.581 (P < 0.001). In 78% (39/50 cases), they had complete agreement upon all aspects of antibiotic treatment. The remaining 11 cases were reviewed by the expert team. Comparing the consensus of 50 cases to actual practice, in 14(28%) cases there was a discrepancy suggesting potential room for improvement. Comparing the cases in whom an individual infectious diseases specialist was involved in real practice to those cases without, there was 18% versus 42% discrepancy with the recommendations of the expert team (OR 3.4; 95% CI: 0.9-12.5, P = 0.06). Complication rate was 19% including unplanned readmissions and side effects of antimicrobial agent or administration route. Conclusion Though outpatient parenteral antimicrobial treatment policies in the Netherlands appear to be safe, consultation of an ID expert team, rather than an individual ID specialist, has the potential to optimize antimicrobial treatment in patients considered suitable for outpatient parenteral antimicrobial treatment.
背景 门诊胃肠外抗菌治疗正受到越来越多的关注。目的 评估传染病专家团队（由两名内科传染病专家和一名微生物学家组成）就抗生素治疗的类型、给药途径和疗程提供建议的附加价值。地点 在荷兰海牙的一家拥有700张床位的地区教学医院哈加教学医院进行了一项回顾性病例系列研究。方法 在60天的随访期间评估并发症发生率和死亡率。通过从数据库中随机选择纸质病例并提交给两名对患者治疗和结果不知情的独立传染病专家，来确定门诊胃肠外抗菌治疗的治疗合理性。使用科恩kappa系数分析两条建议之间的一致性。对于存在分歧的情况，组织了一次传染病专家团队会议以达成共识。将最终建议与实际给予的抗生素治疗进行比较。主要结局指标 传染病专家团队在抗生素的类型、给药途径和疗程方面的建议与实际门诊胃肠外抗菌治疗实践之间的差异。结果 在纳入的89例病例中，随机选择了50例由传染病专家进行审查。关于抗菌策略的kappa统计量为0.581（P < 0.001）。在78%（39/50例）的病例中，他们在抗生素治疗的所有方面完全一致。其余11例病例由专家团队进行审查。将50例病例的共识与实际实践进行比较，在14例（28%）病例中存在差异，表明有潜在的改进空间。将实际参与实践的个体传染病专家的病例与未参与的病例进行比较，与专家团队的建议存在差异的比例分别为18%和42%（OR 3.4；95% CI：0.9 - 12.5，P = 0.06）。并发症发生率为19%，包括计划外再次入院以及抗菌药物或给药途径的副作用。结论 尽管荷兰的门诊胃肠外抗菌治疗政策似乎是安全的，但咨询传染病专家团队而非个体传染病专家，有可能优化适合门诊胃肠外抗菌治疗患者的抗菌治疗。
