O'Keefe Caitlan, Thompson Angus, McKenzie Duncan, Lee Kenneth
Pharmacy Department, Tasmanian Health Service, Royal Hobart Hospital, Hobart, Tasmania, Australia.
Division of Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.
Int J Clin Pract. 2019 Oct 1:e13427. doi: 10.1111/ijcp.13427.
Background Appropriate antibiotic prescribing improves patient outcomes and mitigates antimicrobial resistance. As the majority of antibiotics are used in the community, rational prescribing in this setting is of paramount importance. Objectives We aimed to (1) evaluate the concordance of community antibiotic prescribing with guidelines for three common infection types among patients who presented to hospital, and (2) identify relationships between guideline concordance and patient-related factors. Methods Medical records were evaluated from the Royal Hobart Hospital (Tasmania, Australia) for patients presenting with respiratory tract, urinary tract or skin and soft tissue infections within a 12-month period. Prior-to-hospital antibiotic therapy was assessed for concordance with prescribing guidelines based on presenting diagnosis. Concordance was assessed against first-line recommendations in the Australian Therapeutic Guidelines - Antibiotic, based on drug choice, dose, frequency and patient factors. Descriptive statistics were performed to address Objective 1. Multivariate logistic regressions were conducted to address Objective 2 with the following independent variables: infection type, age, allergies, diabetes status, gender and residential setting. Results A total of 285 patient records were eligible for data analysis; 28.8% (n = 82) were fully guideline concordant. The most common reason for non-concordance was inappropriate drug choice (n = 143, 50.2%). Patients with the following characteristics were less likely to receive concordant therapy: diabetes (OR = 0.3, 95% CI 0.1-0.8, P = .02) and increasing age (OR = 0.99, 95% CI 0.98-1.00, P = .04). Conclusions Almost three-quarters of patients received community-initiated antibiotic therapy that was not fully guideline concordant. Antimicrobial stewardship interventions are urgently needed to improve guideline concordance for community-initiated antibiotic therapy.
背景 合理使用抗生素可改善患者预后并减轻抗菌药物耐药性。由于大多数抗生素在社区中使用，因此在这种情况下合理用药至关重要。目的 我们旨在（1）评估社区抗生素处方与因三种常见感染类型入院患者指南的一致性，以及（2）确定指南一致性与患者相关因素之间的关系。方法 对澳大利亚塔斯马尼亚州皇家霍巴特医院12个月内出现呼吸道、泌尿道或皮肤及软组织感染的患者的病历进行评估。根据就诊诊断评估入院前抗生素治疗与处方指南的一致性。根据澳大利亚治疗指南 - 抗生素中的一线建议，基于药物选择、剂量、频率和患者因素评估一致性。进行描述性统计以实现目标1。进行多变量逻辑回归以实现目标2，自变量如下：感染类型、年龄、过敏、糖尿病状态、性别和居住环境。结果 共有285份患者记录符合数据分析条件；28.8%（n = 82）完全符合指南。不一致的最常见原因是药物选择不当（n = 143，50.2%）。具有以下特征的患者接受一致治疗的可能性较小：糖尿病（OR = 0.3，95%CI 0.1 - 0.8，P = .02）和年龄增加（OR = 0.99，95%CI 0.98 - 1.00，P = .04）。结论 近四分之三的患者接受的社区启动的抗生素治疗不完全符合指南。迫切需要抗菌药物管理干预措施，以提高社区启动的抗生素治疗的指南一致性。
