Department of Pharmacy, TriStar Skyline Medical Center, 3441 Dickerson Pike, Nashville, TN, 37207, USA.
Int J Clin Pharm. 2021 Oct;43(5):1345-1351. doi: 10.1007/s11096-021-01257-8. Epub 2021 Mar 7.
Background Antimicrobial stewardship initiatives combining restrictive and enabling components may be an effective strategy to achieve short- and long-term objectives. Aztreonam, a relatively high-cost antipseudomonal antibiotic, is an appropriate target for stewardship initiatives based on propensity for overuse in penicillin allergy, an activity profile often warranting additional empiric gram-negative and gram-positive coverage, and a unique durability to Ambler class B metallo-beta-lactamases. Objective Analyze the immediate and long-term impact on aztreonam prescribing of combining restrictive and enabling interventions. Setting Single 233-bed community hospital with 45 adult intensive care unit beds in Nashville, Tennessee. Method Retrospective, interrupted time series analysis comparing all patients receiving aztreonam prior to intervention between January 1, 2010 and September 30, 2011 and following intervention between October 1, 2011 and September 30, 2019. Quarterly defined daily doses/1000 adjusted patient days and microbiology laboratory annual surveillance data were utilized for analysis. Main outcome measure Post-intervention change in trend of aztreonam consumption. Results Following intervention, a significant decline in aztreonam consumption was observed (- 1.97 defined daily doses/1000 adjusted patient days; p = 0.003) resulting in a sustained decrease in aztreonam consumption from 2011 (3rd quarter) to 2019 (3rd quarter) from 15.2 to 0.26 defined daily doses/1000 adjusted patient days. Short-term group 2 carbapenem consumption increased (p = 0.044). Pseudomonas aeruginosa susceptibility to aztreonam improved from 2011 to 2018 (72% vs. 84%; p = 0.0004) without deleterious effects to alternative antipseudomonal beta-lactams. Conclusion Combining restrictive and enabling interventions had immediate and sustained impact on aztreonam consumption with P. aeruginosa susceptibility improvement.
联合限制和支持措施的抗菌药物管理举措可能是实现短期和长期目标的有效策略。氨曲南是一种相对昂贵的抗假单胞菌抗生素，由于在青霉素过敏的情况下过度使用的倾向、通常需要额外的经验性革兰阴性和革兰阳性覆盖的作用谱以及对 Ambler 类 B 金属β-内酰胺酶的独特耐久性，因此是管理举措的合适目标。目的：分析联合限制和支持干预措施对氨曲南处方的即时和长期影响。地点：田纳西州纳什维尔的一家拥有 45 张成人重症监护病床的 233 张病床的单社区医院。方法：回顾性、中断时间序列分析，比较干预前（2010 年 1 月 1 日至 2011 年 9 月 30 日）和干预后（2011 年 10 月 1 日至 2019 年 9 月 30 日）所有接受氨曲南治疗的患者。每季度的定义日剂量/1000 调整后的患者日和微生物学实验室年度监测数据用于分析。主要结果测量：干预后氨曲南消耗趋势的变化。结果：干预后，氨曲南的使用量明显下降（-1.97 定义日剂量/1000 调整后的患者日；p=0.003），导致从 2011 年（第 3 季度）到 2019 年（第 3 季度），氨曲南的使用量从 15.2 降至 0.26 定义日剂量/1000 调整后的患者日。短期组 2 碳青霉烯类药物的消耗量增加（p=0.044）。2011 年至 2018 年，铜绿假单胞菌对氨曲南的敏感性提高（72%对 84%；p=0.0004），而对替代抗假单胞菌β-内酰胺类药物没有不良影响。结论：联合限制和支持措施对氨曲南的使用产生了即时和持续的影响，并改善了铜绿假单胞菌的敏感性。
