University Health Network, Toronto, Ontario, M5G 2N2, Canada.
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
Eur J Clin Microbiol Infect Dis. 2019 Oct;38(10):1915-1923. doi: 10.1007/s10096-019-03626-8. Epub 2019 Jul 19.
We implemented twice-weekly academic detailing rounds in 2015 as an antimicrobial stewardship (AMS) intervention in solid organ transplant (SOT) patients, led by an AMS pharmacist and a transplant infectious diseases physician. They reviewed SOT patients' antimicrobials and made recommendations to prescribers on antimicrobial regimens, diagnostics investigations, and appropriate referrals for transplant infectious diseases consultation. To determine the impact of the intervention, we adjudicated antimicrobials prescriptions using established AMS principles, and compared the proportion of AMS-concordance regimens pre-intervention (2013) with post-intervention (2016) via 4-point-prevalence surveys conducted in each period. All admitted SOT patients who were receiving antimicrobial treatment on survey days were included. Primary outcome was the percentage of antimicrobial regimen adjudicated as AMS concordant. Secondary outcomes were percentage of AMS concordance in patients consulted by transplant infectious diseases; categories of AMS discordance; antimicrobial consumption in defined daily dose/100 patient-days (DDD/100PD); antimicrobial cost in CAD$/PD; and C. difficile infections. Balancing measures were length of stay, 30-day readmission, and in-hospital mortality. We compared outcomes using χ test or t-test; significant difference was defined as p < 0.05. Pre-intervention surveys included 139 patients, post-intervention, 179 patients, with 62.3% vs. 56.6% receiving antimicrobials, respectively (p = 0.27). AMS concordance increased from 69% (60/87) to 83.7% (93/111), p = 0.01. Not tailoring antimicrobials was the most common discordance category. AMS concordance under transplant infectious diseases was 82.5% (33/40) pre-intervention vs. 76.6% (36/47) post-intervention, p = 0.5. Antimicrobial consumption increased by 15.3% (140.9 vs.162.4 DDD/100PD, p = 0.001). Antimicrobial cost, C. difficile infection rates and balancing measures remained stable. Academic detailing increased appropriate antimicrobial use in SOT patients without untoward effects.
我们在 2015 年实施了每周两次的学术详细审查轮次，作为实体器官移植 (SOT) 患者的抗菌药物管理 (AMS) 干预措施，由一名 AMS 药剂师和一名移植传染病医生领导。他们审查了 SOT 患者的抗生素，并就抗生素方案、诊断检查以及适当的传染病会诊转诊向处方医生提出建议。为了确定干预措施的影响，我们使用既定的 AMS 原则来裁定抗生素处方，并通过在每个时期进行的 4 点患病率调查，比较干预前（2013 年）和干预后（2016 年）的 AMS 一致方案的比例。所有在调查日接受抗生素治疗的住院 SOT 患者均包括在内。主要结局是裁定为 AMS 一致的抗生素方案的百分比。次要结局是由移植传染病医生咨询的患者的 AMS 一致性百分比；AMS 不一致的类别；定义日剂量/100 患者日（DDD/100PD）的抗生素消耗；CAD$/PD 的抗生素费用；和艰难梭菌感染。平衡措施是住院时间、30 天再入院和院内死亡率。我们使用 χ 检验或 t 检验比较结果；显著差异定义为 p<0.05。干预前的调查包括 139 名患者，干预后的调查包括 179 名患者，分别有 62.3%和 56.6%的患者接受抗生素治疗（p=0.27）。AMS 一致性从 69%（60/87）增加到 83.7%（93/111），p=0.01。未调整抗生素是最常见的不一致类别。移植传染病医生下的 AMS 一致性在干预前为 82.5%（33/40），在干预后为 76.6%（36/47），p=0.5。抗生素消耗增加了 15.3%（140.9 比 162.4 DDD/100PD，p=0.001）。抗生素费用、艰难梭菌感染率和平衡措施保持稳定。学术详细审查增加了 SOT 患者适当使用抗生素，而没有不良影响。
