Bishop Paige A, Isache Carmen, McCarter Yvette S, Smotherman Carmen, Gautam Shiva, Jankowski Christopher A
Department of Pharmacy, University of Florida Health at Jacksonville, Jacksonville, Florida, USA.
Department of Medicine, UF Health Jacksonville, Jacksonville, Florida, USA.
J Investig Med. 2020 Apr;68(4):888-892. doi: 10.1136/jim-2019-001173. Epub 2020 Feb 16.
is the most common cause of healthcare-associated infection and gastroenteritis-associated death in the USA. Adherence to guideline recommendations for treatment of severe infection (CDI) is associated with improved clinical success and reduced mortality. The purpose of this study was to determine whether implementation of a pharmacist-led antimicrobial stewardship program (ASP) CDI initiative improved adherence to CDI treatment guidelines and clinical outcomes. This was a single-center, retrospective, quasi-experimental study evaluating patients with CDI before and after implementation of an ASP initiative involving prospective audit and feedback in which guideline-driven treatment recommendations were communicated to treatment teams and documented in the electronic health record via pharmacy progress notes for all patients diagnosed with CDI. The primary endpoint was the proportion of patients treated with guideline adherent definitive regimens within 72 hours of CDI diagnosis. Secondary objectives were to evaluate the impact on clinical outcomes, including length of stay (LOS), infection-related LOS, 30-day readmission rates, and all-cause, in-hospital mortality. A total of 233 patients were evaluated. The proportion of patients on guideline adherent definitive CDI treatment regimen within 72 hours of diagnosis was significantly higher in the post-interventional group (pre: 42% vs post: 58%, p=0.02). No differences were observed in clinical outcomes or proportions of patients receiving laxatives, promotility agents, or proton pump inhibitors within 72 hours of diagnosis. Our findings demonstrate that a pharmacist-led stewardship initiative improved adherence to evidence-based practice guidelines for CDI treatment.
在美国，（艰难梭菌感染）是医疗保健相关感染和肠胃炎相关死亡的最常见原因。遵循严重感染（艰难梭菌感染）治疗的指南建议与临床治疗成功率提高及死亡率降低相关。本研究的目的是确定实施由药剂师主导的抗菌药物管理计划（ASP）艰难梭菌感染倡议是否能提高对艰难梭菌感染治疗指南的遵循度及改善临床结局。这是一项单中心、回顾性、准实验性研究，评估了在实施一项ASP倡议前后的艰难梭菌感染患者，该倡议包括前瞻性审核与反馈，即将基于指南的治疗建议传达给治疗团队，并通过药房病程记录记录在所有诊断为艰难梭菌感染患者的电子健康记录中。主要终点是在艰难梭菌感染诊断后72小时内接受符合指南的确定性治疗方案治疗的患者比例。次要目标是评估对临床结局的影响，包括住院时间（LOS）、感染相关住院时间、30天再入院率以及全因院内死亡率。总共评估了233例患者。干预后组在诊断后72小时内接受符合指南的确定性艰难梭菌感染治疗方案的患者比例显著更高（干预前：42% vs干预后：58%，p = 0.02）。在临床结局或诊断后72小时内接受泻药、促动力药或质子泵抑制剂治疗的患者比例方面未观察到差异。我们的研究结果表明，由药剂师主导的管理倡议提高了对艰难梭菌感染治疗循证实践指南的遵循度。
