Moriyama Yuki, Ishikane Masahiro, Hayakawa Kayoko, Yamamoto Kei, Akazawa Tsubasa, Sugiki Yuko, Ohmagari Norio
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan.
J Infect Chemother. 2019 May;25(5):396-399. doi: 10.1016/j.jiac.2018.11.006. Epub 2018 Dec 1.
Staphylococcus aureus bacteremia (SAB) and candidemia have significant impacts on mortality. Both have important implications for antimicrobial stewardship programs (ASPs). However, there are limited data regarding who should be educated and what components should be considered for the ASPs. Hence, we investigated the possibility of the key elements for implications of SAB and candidemia managements for ASPs. We conducted a cross-sectional study on the knowledge of antimicrobial stewardship institution policies targeting SAB and candidemia for all medical doctors (MDs) and pharmacists to using an E-learning system. To compare the differences in proportions of appropriate knowledge between junior residents and other MDs, and all MDs and pharmacists, we performed bivariate analyses using Fisher's exact test and χ test with odds ratios (ORs) with 95% confidence intervals (CIs). In total, all 395 MDs (71 junior residents, 137 senior residents and fellows, and 187 attending doctors) and all 63 pharmacists including 4 antimicrobial stewardship teams pharmacists responded to survey. MDs other than junior residents responded significantly inappropriately to the questions on the candidemia than junior residents (OR = 0.6, 95% CI: 0.4-1.0). Pharmacists had a significantly lower proportion of appropriate knowledge to the candidemia than MDs (OR = 0.4, 95% CI: 0.2-0.8). The major pitfall was failure to consult an ophthalmologist (82.5%). Next step, we will conduct educational intervention about institution policies, and evaluate whether to improve the knowledges and practices by pre-post test and chart review.
金黄色葡萄球菌菌血症(SAB)和念珠菌血症对死亡率有重大影响。两者对抗菌药物管理计划(ASP)都具有重要意义。然而,关于哪些人应该接受教育以及ASP应考虑哪些组成部分的数据有限。因此,我们调查了SAB和念珠菌血症管理对ASP影响的关键因素。我们使用电子学习系统,针对所有医生(MD)和药剂师开展了一项关于针对SAB和念珠菌血症的抗菌药物管理机构政策知识的横断面研究。为了比较初级住院医师与其他MD以及所有MD与药剂师之间适当知识比例的差异,我们使用Fisher精确检验和χ检验进行双变量分析,并计算95%置信区间(CI)的比值比(OR)。共有395名MD(71名初级住院医师、137名高级住院医师和研究员以及187名主治医生)和包括4名抗菌药物管理团队药剂师在内的所有63名药剂师参与了调查。除初级住院医师外的MD对念珠菌血症问题的回答明显不如初级住院医师恰当(OR = 0.6,95% CI:0.4 - 1.0)。药剂师对念珠菌血症的适当知识比例明显低于MD(OR = 0.4,95% CI:0.2 - 0.8)。主要缺陷是未咨询眼科医生(82.5%)。下一步,我们将开展关于机构政策的教育干预,并通过前后测试和病历审查评估是否能提高知识水平和实践能力。