Song Jiyoun, Cohen Bevin, Liu Jianfang, Larson Elaine, Zachariah Philip
Columbia University School of Nursing, New York, New York.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
Curr Ther Res Clin Exp. 2020 Aug 5;93:100600. doi: 10.1016/j.curtheres.2020.100600. eCollection 2020.
Although antibiotic use is an established risk factor for health care-associated infection, estimates of the association between infection and antibiotic use vary, depending upon how antibiotic exposure is measured.
The purpose of this study was to explore the association between the frequency of interruptions in antibiotic exposure and the risk of health care-associated infection.
A retrospective chart review cohort study was conducted of all inpatients between 2011and 2016 from a single academic health center who received at least 1 dose of a systemic antibacterial for a cumulative duration of >3 days and ≤30 days. The measures of antibiotic exposure examined were durationcumulative total calendar days of antibiotics therapy-and continuity-the frequency of interruptions in antibiotic exposure that was defined as the number of antibiotic treatment courses.
A total of 52,445/227,967 (23%) patients received antibacterial therapy for >3 days and ≤30 days during their hospitalization. Of these, 1161 out of 52,445 (2.21%) were patients with health care-associated infection. An adjusted multivariable logistic regression analysis revealed that the risk of increased with longer cumulative days (odds ratio = 2.7; comparison of >12 days to ≤5 days) and fewer interruptions of antibiotic treatment (odds ratio = 0.78; comparison of >3 discrete antibiotic treatment courses to 1 course or continuous antibiotic treatment course; all values < 0.05).
For patients who received the same number of cumulative days of therapy, the patients who had more frequently interrupted courses of antibiotic therapy were less likely to experience health care-associated infection. (. 2020; 81:XXX-XXX).
尽管抗生素使用是医疗保健相关感染的既定风险因素，但感染与抗生素使用之间关联的估计值各不相同，这取决于抗生素暴露的测量方式。
本研究的目的是探讨抗生素暴露中断频率与医疗保健相关感染风险之间的关联。
对2011年至2016年期间来自单一学术医疗中心的所有住院患者进行回顾性病历队列研究，这些患者接受了至少1剂全身性抗菌药物治疗，累积疗程超过3天且≤30天。所检查的抗生素暴露指标包括疗程（抗生素治疗的累计总日历天数）和连续性（抗生素暴露中断的频率，定义为抗生素治疗疗程数）。
共有52445/227967（23%）的患者在住院期间接受了超过3天且≤30天的抗菌治疗。其中，52445名患者中有1161名（2.21%）发生了医疗保健相关感染。多变量校正逻辑回归分析显示，累积天数越长（比值比=2.7；比较>12天与≤5天）和抗生素治疗中断次数越少（比值比=0.78；比较>3个离散抗生素治疗疗程与1个疗程或连续抗生素治疗疗程；所有P值<0.05），感染风险越高。
对于接受相同累积治疗天数的患者，抗生素治疗疗程中断更频繁的患者发生医疗保健相关感染的可能性较小。（. 2020；81：XXX - XXX）
