University of Maryland School of Medicine, Division of Infectious Diseases, Baltimore, Maryland, USA
University of Maryland Medical Center, Department of Medicine, Baltimore, Maryland, USA.
Antimicrob Agents Chemother. 2020 Jul 22;64(8). doi: 10.1128/AAC.00307-20.
Hospital-based antibiotic stewardship (AS) programs provide oversight and guidance for appropriate antimicrobial use in acute care settings. Infectious disease expertise is beneficial in the care of hospitalized patients with infections. The impact of infectious diseases consultation (IDC) on antimicrobial appropriateness in a large tertiary hospital with an established AS program was investigated. This was a cross-sectional study from October 2017 to March 2019 at a large academic hospital with an AS-directed prospective audit and feedback process and multiple IDC services. Antimicrobial appropriateness was adjudicated by an AS team member after antimicrobial start. Antimicrobial appropriateness was compared among antimicrobial orders with and without IDC using propensity score matching and multivariable logistic regression. Analyses were stratified by primary services caring for the patients. There were 10,508 antimicrobial orders from 6,165 unique patient encounters. Overall appropriateness was 92%, with higher appropriateness among patients with IDC versus without IDC (94% versus 84%; < 0.0001). After propensity score matching and adjustment for certain antibiotics, organisms, syndromes, and locations, IDC was associated with a greater antimicrobial appropriateness odds ratio (OR) of 2.4 (95% confidence interval [CI], 1.9 to 3.0). Stratification by primary service showed an OR of 2.9 (95% CI, 2.1 to 3.8) for surgical specialties and an OR of 1.6 (95% CI, 1.1 to 2.2) for medical specialties. Even with a high overall antimicrobial appropriateness, patients with IDC had greater odds of antimicrobial appropriateness than those without IDC, and this impact was greater in surgical specialties. Infectious diseases consultation can be synergistic with antimicrobial stewardship programs.
医院为基础的抗生素管理（AS）计划为急性护理环境中的适当抗菌药物使用提供监督和指导。传染病专业知识对于住院感染患者的护理是有益的。本研究旨在调查在一家拥有既定 AS 计划的大型三级医院中，传染病会诊（IDC）对抗菌药物适当性的影响。这是一项 2017 年 10 月至 2019 年 3 月在一家大型学术医院进行的横断面研究，该医院采用 AS 指导的前瞻性审核和反馈流程以及多种 IDC 服务。抗菌药物开始后，由 AS 团队成员判断抗菌药物的适当性。使用倾向评分匹配和多变量逻辑回归比较有和没有 IDC 的抗菌药物医嘱的抗菌药物适当性。分析按主要服务科室分层。共有 10508 份来自 6165 个独特患者的抗菌药物医嘱。总体适当性为 92%，有 IDC 的患者比没有 IDC 的患者（94%比 84%；<0.0001）更高。在进行倾向评分匹配和调整某些抗生素、病原体、综合征和部位后，IDC 与更高的抗菌药物适当性比值比（OR）相关，为 2.4（95%置信区间 [CI]，1.9 至 3.0）。按主要服务科室分层，外科专业的 OR 为 2.9（95% CI，2.1 至 3.8），内科专业的 OR 为 1.6（95% CI，1.1 至 2.2）。即使整体抗菌药物适当性较高，有 IDC 的患者抗菌药物适当性的可能性也高于没有 IDC 的患者，这种影响在外科专业更大。传染病会诊可以与抗菌药物管理计划协同作用。
