Department of Medicine and Division of Infectious Diseases, Denver Health, Denver, Colorado, USA.
Department of Patient Safety and Quality, Denver Health, Denver, Colorado, USA.
Clin Infect Dis. 2021 Apr 26;72(8):1457-1462. doi: 10.1093/cid/ciaa1003.
United States guidance for hospital antibiotic stewardship has emphasized prospective audit and feedback and prior authorization of select antibiotics as core interventions. These remain the most common interventions implemented by stewardship programs. Although these approaches have been shown to reduce unnecessary antibiotic use, they incorrectly put the onus for appropriate antibiotic use on the stewardship team rather than the prescribing clinician. We propose that a primary focus of stewardship programs should be implementation of broader interventions that engage frontline clinicians and equip them with tools to integrate antibiotic stewardship into their own daily practice, thus reducing the need for day-to-day stewardship team oversite. We discuss a framework of broader interventions and policies that will facilitate this paradigm shift.
美国的医院抗生素管理指南强调了前瞻性审核和反馈以及选择性抗生素的事先授权作为核心干预措施。这些仍然是管理计划中最常见的干预措施。尽管这些方法已被证明可以减少不必要的抗生素使用，但它们错误地将适当使用抗生素的责任推给了管理团队，而不是处方医生。我们建议，管理计划的主要重点应该是实施更广泛的干预措施，使一线临床医生参与其中，并为他们提供工具，将抗生素管理纳入自己的日常实践中，从而减少日常管理团队监督的需要。我们讨论了一个更广泛的干预措施和政策框架，这将有助于这种模式转变。
