Udine Healthcare and University Integrated Trust, Udine, Italy - Department of Medicine, University of Udine, Italy - Present affiliation: Codroipo District, Local Health Trust no. 3, Gemona, Italy.
Department of Medicine, University of Udine, Italy.
Ann Ig. 2020 Jul-Aug;32(4):344-356. doi: 10.7416/ai.2020.2358.
Local guidelines and recommendations to treat common infectious diseases are a cornerstone of most Antimicrobial Stewardship programs. The evaluation of the adherence to guidelines is an effective quality measure of the programs themselves; the proposed evaluation model aimed at examining antibiotic treatment for pneumonia.
A retrospective pre-post intervention study was conducted in a North-Eastern Italian Academic Hospital.
231 patients with Community-Acquired Pneumonia and 95 with Healthcare-Associated Pneumonia were divided into pre- and post-intervention groups (188 and 138, respectively). A course and a pocket summary of Pneumonia Regional Recommendations were the stewardship activities adopted. The compliance degree of prescriptions with Regional Recommendations was tested for drug(s), dosage and duration of treatment in both groups for Community-Acquired and Healthcare-Associated Pneumonia and a comparison with International guidelines was performed.
A significant improvement in the compliance with Regional Recommendations for the variable drug emerged for Community-Acquired (38.8% vs 52.2%), but not for Healthcare-Associated Pneumonia; no significant variation in compliance was registered for dosage and duration of treatment. The significant decrease in consumption of levofloxacin showed the positive impact of the Regional Antimicrobial Stewardship programs. A high level of adherence to International Guidelines for the variable drug for Community-Acquired Pneumonia was found in both groups (75.5% and 77.2%, respectively).
Our study highlighted that room for improvement in antibiotic prescription in Community-Acquired and Healthcare-Associated Pneumonia currently remains. New strategies for a better use of the adopted tools and definition of new antimicrobial stewardship initiatives are needed to improve compliance to Regional Recommendations.
治疗常见传染病的地方指南和建议是大多数抗菌药物管理计划的基石。评估对指南的遵守情况是对计划本身进行有效质量衡量的一种手段；提出的评估模型旨在检查肺炎的抗生素治疗。
在意大利东北部的一家学术医院进行了一项回顾性前后干预研究。
将 231 例社区获得性肺炎和 95 例医疗保健相关性肺炎患者分为干预前和干预后组（分别为 188 例和 138 例）。采用肺炎区域推荐的治疗方案和袖珍摘要作为管理活动。对两组患者的社区获得性和医疗保健相关性肺炎的治疗药物、剂量和持续时间进行了区域推荐的处方遵守程度测试，并与国际指南进行了比较。
在社区获得性肺炎中，药物变量的区域推荐遵守程度显著提高（38.8%比 52.2%），但在医疗保健相关性肺炎中没有显著变化；剂量和治疗持续时间的遵守情况没有显著变化。左氧氟沙星的使用量显著减少，表明区域抗菌药物管理计划产生了积极影响。两组患者的社区获得性肺炎药物变量都高度符合国际指南（分别为 75.5%和 77.2%）。
我们的研究表明，目前社区获得性和医疗保健相关性肺炎的抗生素处方仍有改进的空间。需要新的策略来更好地利用所采用的工具，并制定新的抗菌药物管理计划，以提高对区域推荐的遵守程度。
