Department of Pharmacy CCLHD, Wyong Hospital, Hamlyn Terrace, NSW, Australia.
Division of Medicine CCLHD, Gosford Hospital, Gosford, NSW, Australia.
BMC Infect Dis. 2022 Feb 8;22(1):135. doi: 10.1186/s12879-022-07117-8.
Antimicrobial resistance (AMR) remains a major public health threat and the exploration of interventions which may reduce inappropriate antimicrobial use are of particular interest. An Antibiotic Hardstop (AH) was included within the eMeds system introduced to the Central Coast Local Health District (CCLHD) in 2018. The function allows prescribers to set a predetermined time at which antibiotic orders would cease. By default, the function set prescribed length to 5 days with a view to encourage prescribers to review existing antimicrobial orders and reduce inappropriate use.
Records of adult inpatients prescribed broad spectrum antimicrobials with a registered indication of community acquired pneumonia (CAP) or an infective exacerbation of chronic obstructive pulmonary disease (IECOPD) between the 1st of March 2017 and 31st May 2017 for the pre eMeds cohort and 1st March 2019 and 31st May 2019 for the post eMeds cohort were randomly selected from our local health network's Guidance MS system. Baseline demographics, antimicrobial prescribing records and documented adverse events related to the AH function were collated/analysed. The days of therapy (DOT) and length of therapy (LOT) for each encounter were calculated manually and results analysed using a two-tailed t-test or Mann-Whitney U test.
Of patients eligible to have the AH function activated during their admission, 34% (n = 34) had the function deployed at least once. Following the introduction of eMeds mean DOT for the pooled indications cohort was reduced by 3.02 days (CI 95% 0.41-5.63, p < 0.05) and mean LOT by 1.97 days (CI 95% 0.39-3.55, p < 0.05). The hardstop function resulted in 2 cases of delayed or unintentionally ceased therapies.
Following the introduction of electronic prescribing and AH, a significant reduction was observed in the DOT and LOT for antimicrobial use for inpatients with CAP and IECOPD without a significant increase in adverse events. Further research is required to determine the extent to which the AH functionality directly contributed to this effect and if the effect is present across a broader range of indications.
抗菌药物耐药性（AMR）仍然是一个主要的公共卫生威胁，探索可能减少不合理使用抗菌药物的干预措施尤其具有重要意义。抗生素硬停止（AH）于 2018 年被纳入引入中央海岸地方卫生区（CCLHD）的电子医疗系统（eMeds）中。该功能允许开处方者设定抗生素订单停止的预定时间。默认情况下，该功能将规定的疗程设定为 5 天，目的是鼓励开处方者审查现有的抗菌药物订单并减少不合理使用。
在 2017 年 3 月 1 日至 2017 年 5 月 31 日期间，从我们当地卫生网络的指导 MS 系统中随机选择了患有社区获得性肺炎（CAP）或慢性阻塞性肺疾病（COPD）感染性加重（IECOPD）的广谱抗菌药物处方的成年住院患者记录，作为 eMeds 前队列；并选择了 2019 年 3 月 1 日至 2019 年 5 月 31 日期间，作为 eMeds 后队列。收集了与 AH 功能相关的基线人口统计学、抗菌药物处方记录和记录的不良事件。手动计算每次就诊的治疗天数（DOT）和治疗时间（LOT），并使用双尾 t 检验或曼-惠特尼 U 检验进行分析。
在有资格在住院期间激活 AH 功能的患者中，有 34%（n=34）至少激活了一次该功能。在引入 eMeds 后，合并适应证队列的平均 DOT 减少了 3.02 天（CI 95%95%置信区间为 0.41-5.63，p<0.05），平均 LOT 减少了 1.97 天（CI 95%置信区间为 0.39-3.55，p<0.05）。硬停功能导致 2 例治疗延迟或意外停止。
在引入电子处方和 AH 后，CAP 和 IECOPD 住院患者的抗菌药物使用的 DOT 和 LOT 显著减少，而不良事件没有显著增加。需要进一步研究以确定 AH 功能在多大程度上直接促成了这一效果，以及这种效果是否存在于更广泛的适应证范围内。
