Mauro James, Kannangara Saman, Peterson Joanne, Livert David, Tuma Roman A
Department of Pharmacy, Easton Hospital, Easton, PA, USA.
Department of Internal Medicine, Division of Infectious Diseases, Saint Francis Memorial Hospital, San Francisco, CA, USA.
JAC Antimicrob Resist. 2021 Aug 12;3(3):dlab118. doi: 10.1093/jacamr/dlab118. eCollection 2021 Sep.
There is limited literature evaluating the effect of antibiotic stewardship programmes (ASPs) in hospitalized geriatric patients, who are at higher risk for readmissions, developing infection (CDI) or other adverse outcomes secondary to antibiotic treatments.
In this cohort study we compare the rates of 30 day hospital readmissions because of reinfection or development of CDI in patients 65 years and older who received ASP interventions between January and June 2017. We also assessed their mortality rates and length of stay. Patients were included if they received antibiotics for pneumonia, urinary tract infection, acute bacterial skin and skin structure infection or complicated intra-abdominal infection. The ASP team reviewed patients on antibiotics daily. ASP interventions included de-escalation of empirical or definitive therapy, change in duration of therapy or discontinuation of therapy. Treatment failure was defined as readmission because of reinfection or a new infection. A control group of patients 65 years and older who received antibiotics between January and June 2015 (pre-ASP) was analysed for comparison.
We demonstrated that the 30 day hospital readmission rate for all infection types decreased during the ASP intervention period from 24.9% to 9.3%, <0.001. The rate of 30 day readmissions because of CDI decreased during the intervention period from 2.4% to 0.30%, =0.02. Mortality in the cohort that underwent ASP interventions decreased from 9.6% to 5.4%, =0.03. Lastly, antibiotic expenditure decreased after implementation of the ASP from $23.3 to $4.3 per adjusted patient day, in just 6 months.
Rigorous de-escalation and curtailing of antibiotic therapies were beneficial and without risk for the hospitalized patients 65 years and over.
评估抗生素管理计划（ASP）对住院老年患者影响的文献有限，这些患者再次入院、发生艰难梭菌感染（CDI）或因抗生素治疗导致其他不良后果的风险更高。
在这项队列研究中，我们比较了2017年1月至6月期间接受ASP干预的65岁及以上患者因再次感染或发生CDI而导致的30天医院再入院率。我们还评估了他们的死亡率和住院时间。如果患者因肺炎、尿路感染、急性细菌性皮肤和皮肤结构感染或复杂性腹腔内感染接受抗生素治疗，则纳入研究。ASP团队每天对接受抗生素治疗的患者进行评估。ASP干预措施包括降阶梯经验性或确定性治疗、改变治疗持续时间或停止治疗。治疗失败定义为因再次感染或新感染而再次入院。分析了2015年1月至6月（ASP实施前）接受抗生素治疗的65岁及以上患者对照组进行比较。
我们证明，在ASP干预期内，所有感染类型的30天医院再入院率从24.9%降至9.3%，<0.001。因CDI导致的30天再入院率在干预期内从2.4%降至0.30%，=0.02。接受ASP干预的队列中的死亡率从9.6%降至5.4%，=0.03。最后，在实施ASP后的6个月内，抗生素支出从每调整患者日23.3美元降至4.3美元。
严格的降阶梯和减少抗生素治疗对65岁及以上的住院患者有益且无风险。
