Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey.
Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey.
Int J Infect Dis. 2019 May;82:40-43. doi: 10.1016/j.ijid.2019.02.044. Epub 2019 Mar 5.
Antimicrobial stewardship programs (ASPs) have an important role in the appropriate utilization of antibiotics. Some of the core strategies recommended for ASPs are pre-authorization and prospective audit and feedback. In Turkey, a unique nationwide antibiotic restriction program (NARP) has been in place since 2003. The aim of this study was to measure the effect of a prospective audit and feedback strategy system along with the NARP.
A prospective quasi-experimental study was designed and implemented between March and June 2017. A computerized pre-authorization system was used as an ASP strategy to approve the antibiotics. During the baseline period, patients with intravenous (IV) antibiotic use ≥72 h were monitored without intervention. In the second period, feedback and treatment recommendations were given to attending physicians in the case of IV antibiotic use ≥72 h. The modified criteria of Kunin et al. and Gyssens et al. were followed for appropriateness of prescribing. Days of therapy (DOT) and length of stay (LOS) were calculated and compared between the two study periods.
A total of 866 antibiotic episodes among 519 patients were observed. A significant reduction in systemic antibiotic consumption was observed in the intervention period (575 vs. 349 DOT per 1000 patient-days; p < 0.001). On multivariate analysis, prospective audit and feedback (odds ratio 1.5, 95% confidence interval 1.09-2.04; p = 0.011) and pre-authorization of restricted antibiotics (odds ratio 1.7; 95% confidence interval 1.2-2.31; p = 0.002) were the predictors of appropriate antimicrobial use. Mean LOS was decreased by 2.9 days (p = 0.095).
This study showed that the antimicrobial restriction program alone was effective, but the system should be supported by a tailored ASP, such as prospective audit and feedback.
抗菌药物管理计划（ASPs）在抗生素的合理使用中具有重要作用。一些推荐的 ASP 核心策略包括预授权和前瞻性审核与反馈。在土耳其，自 2003 年以来一直实施一项独特的全国抗生素限制计划（NARP）。本研究旨在评估前瞻性审核与反馈策略系统与 NARP 共同实施的效果。
设计并实施了一项前瞻性准实验研究，时间为 2017 年 3 月至 6 月。采用计算机化预授权系统作为批准抗生素的 ASP 策略。在基线期，不进行干预，监测静脉（IV）抗生素使用≥72 小时的患者。在第二期，对于 IV 抗生素使用≥72 小时的情况，向主治医生提供反馈和治疗建议。根据 Kunin 等人和 Gyssens 等人的改良标准，评估处方的适宜性。计算并比较两个研究期的治疗日数（DOT）和住院时间（LOS）。
共观察到 519 名患者的 866 个抗生素疗程。干预期系统抗生素的总消耗量显著减少（每 1000 个患者天的系统抗生素消耗分别为 575 比 349 DOT；p<0.001）。多变量分析显示，前瞻性审核与反馈（比值比 1.5，95%置信区间 1.09-2.04；p=0.011）和限制使用抗生素的预授权（比值比 1.7；95%置信区间 1.2-2.31；p=0.002）是适当使用抗菌药物的预测因素。平均 LOS 缩短了 2.9 天（p=0.095）。
本研究表明，单独的抗菌药物限制计划是有效的，但该系统应得到定制的 ASP 的支持，如前瞻性审核与反馈。
