Research Service, Veterans Affairs Northeast Ohio Healthcare System, Cleveland, Ohio, USA.
Geriatric Research Education and Clinical Center, Veterans Affairs Northeast Ohio Healthcare System, Cleveland, Ohio, USA.
Clin Infect Dis. 2021 Jul 15;73(2):344-350. doi: 10.1093/cid/ciaa1769.
The complexities of antibiotic resistance mean that successful stewardship must consider both the effectiveness of a given antibiotic and the spectrum of that therapy to minimize imposing further selective pressure. To meet this challenge, we propose the Desirability of Outcome Ranking approach for the Management of Antimicrobial Therapy (DOOR MAT), a flexible quantitative framework that evaluates the desirability of antibiotic selection. Herein, we describe the steps required to implement DOOR MAT and present examples to illustrate how the desirability of treatment selection can be evaluated using resistance information. While treatments and the scoring of treatment selections must be adapted to specific clinical settings, the principle of DOOR MAT remains constant: The most desirable antibiotic choice effectively treats the patient while exerting minimal pressure on future resistance.
抗生素耐药性的复杂性意味着成功的管理必须同时考虑给定抗生素的有效性和该治疗的广谱性，以最大限度地减少进一步施加的选择压力。为了应对这一挑战，我们提出了用于管理抗菌治疗的结果排序方法（Desirability of Outcome Ranking approach for the Management of Antimicrobial Therapy，DOOR MAT），这是一种灵活的定量框架，用于评估抗生素选择的适宜性。在此，我们描述了实施 DOOR MAT 所需的步骤，并提供了示例来说明如何使用耐药信息评估治疗选择的适宜性。虽然治疗方法和治疗选择的评分必须适应特定的临床环境，但 DOOR MAT 的原则保持不变：最理想的抗生素选择可以有效地治疗患者，同时对未来的耐药性施加最小的压力。
