抗菌药物管理团队干预对厌氧性菌血症的影响。
The effect of intervention by an antimicrobial stewardship team on anaerobic bacteremia.
作者信息
Kuwabara Gaku, Yukawa Satomi, Yamada Koichi, Imoto Waki, Yamairi Kazushi, Shibata Wataru, Yoshii Naoko, Watanabe Tetsuya, Asai Kazuhisa, Niki Makoto, Nakaie Kiyotaka, Okada Yasuyo, Fujita Akiko, Kaneko Yukihiro, Kawaguchi Tomoya, Kakeya Hiroshi
机构信息
Department of Infection Control Science, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8585, Japan; Department of Infection Control and Prevention, Osaka City University Hospital, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8585, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8585, Japan.
Department of Infection Control Science, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8585, Japan; Department of Infection Control and Prevention, Osaka City University Hospital, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8585, Japan; Research Center for Infectious Diseases, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8585, Japan.
出版信息
Anaerobe. 2020 Aug;64:102214. doi: 10.1016/j.anaerobe.2020.102214. Epub 2020 May 21.
The effect of antimicrobial stewardship (AS) on anaerobic bacteremia is uncertain. This study aimed to assess the effect of interventions by the AS team (AST) on clinical and microbiological outcomes and antimicrobial use. An AS program was introduced at Osaka City University Hospital in January 2014; an interdisciplinary AST was established. We enrolled patients with anaerobic bacteremia between January 2009 and December 2018. Patients were classified into the pre-intervention group (from January 2009 to December 2013) and the post-intervention group (from January 2014 to December 2018). A significant decrease in definitive carbapenem use (P = 0.0242) and an increase in empiric tazobactam/piperacillin use (P = 0.0262) were observed in the post-intervention group. The de-escalation rate increased significantly from 9.38% to 32.7% (P = 0.0316) in the post-intervention group. The susceptibility of Bacteroides species and 30-day mortality did not worsen in the post-intervention group. These results showed that interventions by an AST can reduce carbapenem use and increase the de-escalation rate without worsening patient outcomes.
抗菌药物管理（AS）对厌氧菌血症的影响尚不确定。本研究旨在评估AS团队（AST）的干预措施对临床和微生物学结局以及抗菌药物使用的影响。大阪市立大学医院于2014年1月引入了一项AS计划；并成立了一个跨学科的AST。我们纳入了2009年1月至2018年12月期间患有厌氧菌血症的患者。患者被分为干预前组（2009年1月至2013年12月）和干预后组（2014年1月至2018年12月）。干预后组中，确诊使用碳青霉烯类药物显著减少（P = 0.0242），经验性使用他唑巴坦/哌拉西林增加（P = 0.0262）。干预后组的降阶梯率从9.38%显著提高到32.7%（P = 0.0316）。干预后组中拟杆菌属的敏感性和30天死亡率并未恶化。这些结果表明，AST的干预措施可以减少碳青霉烯类药物的使用并提高降阶梯率，而不会使患者结局恶化。
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