Department of Pharmacy,Ochsner Health System,New Orleans, Louisiana.
Pharmacy Service,Boise Veterans Affairs Medical Center,Boise, Idaho.
Infect Control Hosp Epidemiol. 2019 Apr;40(4):438-446. doi: 10.1017/ice.2019.16.
Antibiotics are overprescribed for acute respiratory tract infections (ARIs). Guidelines provide criteria to determine which patients should receive antibiotics. We assessed congruence between documentation of ARI diagnostic and treatment practices with guideline recommendations, treatment appropriateness, and outcomes.
A multicenter quality improvement evaluation was conducted in 28 Veterans Affairs facilities. We included visits for pharyngitis, rhinosinusitis, bronchitis, and upper respiratory tract infections (URI-NOS) that occurred during the 2015-2016 winter season. A manual record review identified complicated cases, which were excluded. Data were extracted for visits meeting criteria, followed by analysis of practice patterns, guideline congruence, and outcomes.
Of 5,740 visits, 4,305 met our inclusion criteria: pharyngitis (n = 558), rhinosinusitis (n = 715), bronchitis (n = 1,155), URI-NOS (n = 1,475), or mixed diagnoses (>1 ARI diagnosis) (n = 402). Antibiotics were prescribed in 68% of visits: pharyngitis (69%), rhinosinusitis (89%), bronchitis (86%), URI-NOS (37%), and mixed diagnosis (86%). Streptococcal diagnostic testing was performed in 33% of pharyngitis visits; group A Streptococcus was identified in 3% of visits. Streptococcal tests were ordered less frequently for patients who received antibiotics (28%) than those who did not receive antibiotics 44%; P < .01). Although 68% of visits for rhinosinusitis had documentation of symptoms, only 32% met diagnostic criteria for antibiotics. Overall, 39% of patients with uncomplicated ARIs received appropriate antibiotic management. The proportion of 30-day return visits for ARI care was similar for appropriate (11%) or inappropriate (10%) antibiotic management (P = .22).
Antibiotics were prescribed in most uncomplicated ARI visits, indicating substantial overuse. Practice was frequently discordant with guideline diagnostic and treatment recommendations.
抗生素在急性呼吸道感染（ARI）的治疗中被过度使用。指南为确定哪些患者应接受抗生素治疗提供了标准。我们评估了 ARI 诊断和治疗实践与指南推荐、治疗适宜性和结果之间的一致性。
在 28 个退伍军人事务设施中进行了一项多中心质量改进评估。我们纳入了在 2015-2016 年冬季发生的咽炎、鼻-鼻窦炎、支气管炎和上呼吸道感染（URI-NOS）的就诊病例。手动记录审查确定了复杂病例，并将其排除在外。符合标准的就诊病例进行数据提取，然后对实践模式、指南一致性和结果进行分析。
在 5740 次就诊中，有 4305 次符合我们的纳入标准：咽炎（n=558）、鼻-鼻窦炎（n=715）、支气管炎（n=1155）、URI-NOS（n=1475）或混合诊断（>1 种 ARI 诊断）（n=402）。抗生素在 68%的就诊中被开具：咽炎（69%）、鼻-鼻窦炎（89%）、支气管炎（86%）、URI-NOS（37%）和混合诊断（86%）。在 33%的咽炎就诊中进行了链球菌诊断性检测；3%的就诊中检出 A 组链球菌。接受抗生素治疗的患者进行链球菌检测的频率较低（28%），而未接受抗生素治疗的患者为 44%；P <.01）。尽管 68%的鼻-鼻窦炎就诊有症状记录，但仅有 32%符合抗生素治疗的诊断标准。总体而言，39%的单纯 ARI 患者接受了适当的抗生素管理。接受适当（11%）或不适当（10%）抗生素管理的 ARI 患者 30 天内复诊的比例相似（P=.22）。
在大多数单纯 ARI 就诊中开具了抗生素，表明存在大量的过度使用。实践与指南诊断和治疗建议经常不一致。
