Departmentof Pharmacy Practice, Ferris State University College of Pharmacy, Grand Rapids, Michigan.
Department of Pharmacy, Mercy Health Saint Mary's, Grand Rapids, Michigan.
Infect Control Hosp Epidemiol. 2019 Nov;40(11):1236-1241. doi: 10.1017/ice.2019.253. Epub 2019 Sep 2.
Medical residents are an important group for antimicrobial stewardship programs (ASPs) to target with interventions aimed at improving antibiotic prescribing. In this study, we compared antimicrobial prescribing practices of 2 academic medical teams receiving different ASP training approaches along with a hospitalist control group.
Retrospective cohort study comparing guideline-concordant antibiotic prescribing for 3 common infections among a family medicine (FM) resident service, an internal medicine (IM) resident service, and hospitalists.
Community teaching hospital.
Adult patients admitted between July 1, 2016, and June 30, 2017, with a discharge diagnosis of pneumonia, cellulitis, and urinary tract infections were reviewed.
All 3 medical teams received identical baseline ASP education and daily antibiotic prescribing audit with feedback via clinical pharmacists. The FM resident service received an additional layer of targeted ASP intervention that included biweekly stewardship-focused rounds with an ASP physician and clinical pharmacist leadership. Guideline-concordant prescribing was assessed based on the institution's ASP guidelines.
Of 1,572 patients, 295 (18.8%) were eligible for inclusion (FM, 96; IM, 69; hospitalist, 130). The percentage of patients receiving guideline-concordant antibiotic selection empirically was similar between groups for all diagnoses (FM, 87.5%; IM, 87%; hospitalist, 83.8%; P = .702). No differences were observed in appropriate definitive antibiotic selection among groups (FM, 92.4%; IM, 89.1%; hospitalist, 89.9%; P = .746). The FM resident service was more likely to prescribe a guideline-concordant duration of therapy across all diagnoses (FM, 74%; IM, 56.5%; hospitalist, 44.6%; P < .001).
Adding dedicated stewardship-focused rounds into the graduate medical curriculum demonstrated increased guideline adherence specifically to duration of therapy recommendations.
医疗住院医师是抗菌药物管理计划（ASPs）的一个重要目标群体，通过干预措施可以提高抗生素的使用。本研究比较了接受不同 ASP 培训方法的 2 个医学学术团队和一个医院医生组的抗菌药物使用情况。
回顾性队列研究比较了家庭医学（FM）住院医师服务、内科（IM）住院医师服务和医院医生在 3 种常见感染性疾病中的指南一致的抗生素处方情况。
社区教学医院。
2016 年 7 月 1 日至 2017 年 6 月 30 日期间因肺炎、蜂窝织炎和尿路感染出院的成年患者。
所有 3 个医疗团队都接受了相同的 ASP 教育基线，并通过临床药师进行了每日抗生素处方审核和反馈。FM 住院医师服务还接受了额外的 ASP 干预，包括每周 2 次的 ASP 医生和临床药师领导的以管理为重点的查房。根据机构的 ASP 指南评估了指南一致的处方情况。
1572 名患者中，有 295 名（18.8%）符合纳入标准（FM，96 名；IM，69 名；医院医生，130 名）。所有诊断的经验性选择指南一致的抗生素的患者比例在组间相似（FM，87.5%；IM，87%；医院医生，83.8%；P=0.702）。组间在适当的明确抗生素选择方面没有差异（FM，92.4%；IM，89.1%；医院医生，89.9%；P=0.746）。FM 住院医师服务在所有诊断中更有可能开出指南一致的治疗时间（FM，74%；IM，56.5%；医院医生，44.6%；P<0.001）。
在研究生医学课程中增加专门的管理重点查房，显示出对治疗时间建议的指南遵循度的增加。
