Ebied Alex M, Antonelli Paige
Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, NC, USA.
University of Florida College of Pharmacy, USA.
Hosp Pharm. 2022 Feb;57(1):83-87. doi: 10.1177/0018578720985425. Epub 2020 Dec 25.
Emergency department (ED) order sets that include skin and soft tissue infections (SSTI) stratification and antimicrobial selection criteria may improve clinical outcomes and appropriateness of initial antibiotic selection. The purpose of this study was to optimize and evaluate antimicrobial prescribing for SSTI in the ED by implementing an institution specific Infectious Diseases Society of America (IDSA) guideline directed computerized provider order entry (CPOE) order set. The primary outcome was the rate of appropriate antibiotic prescribing for SSTI in the ED before and after order set revision. Secondary outcomes were length of hospital stay, rate of continuity of antibiotics from the ED to hospital admission orders, and frequency of order set utilization. This was a single-centered, retrospective, cohort study. The ED SSTI order set revision reflected current IDSA guidelines, institution formulary, and institution antibiogram. A total of 180 patients were included in the study. The rate of appropriate antibiotic prescribing was 74.4% and 78.9% ( = .60) in the pre-revision and post-revision groups, respectively. Length of hospital stay of admitted patients was 4.93 and 4.32 days ( = .61). Rate of antibiotics continued from the ED to admission was 62.1% and 59.4% ( = .99). Order set utilization was 17.8% and 24.4% ( = .36). A subgroup analysis found appropriateness increased with order set use in admitted patients (50% vs 88.2%; = .0382) and total patients (50% vs 81.8%; = .037). An order set reflective of current IDSA guidelines and institution specific antibiogram showed a similar rate of appropriate antibiotic selection compared to provider's clinical judgment. Provider awareness of SSTI management could have been a limitation to the study.
包含皮肤和软组织感染（SSTI）分层及抗菌药物选择标准的急诊科（ED）医嘱集，可能会改善临床结局以及初始抗生素选择的合理性。本研究的目的是通过实施一项针对机构的、由美国感染病学会（IDSA）指南指导的计算机医嘱录入（CPOE）医嘱集，来优化和评估急诊科SSTI的抗菌药物处方。主要结局是医嘱集修订前后急诊科SSTI的抗生素处方合理率。次要结局包括住院时间、从急诊科到住院医嘱的抗生素延续率以及医嘱集的使用频率。这是一项单中心、回顾性队列研究。急诊科SSTI医嘱集修订反映了当前的IDSA指南、机构处方集和机构抗菌谱。共有180例患者纳入研究。修订前组和修订后组的抗生素处方合理率分别为74.4%和78.9%（P = 0.60）。入院患者的住院时间分别为4.93天和4.32天（P = 0.61）。从急诊科延续到住院的抗生素使用率分别为62.1%和59.4%（P = 0.99）。医嘱集使用率分别为17.8%和24.4%（P = 0.36）。亚组分析发现，在入院患者（50%对88.2%；P = 0.0382）和所有患者（50%对81.8%；P = 0.037）中，医嘱集的使用使处方合理性增加。与医生的临床判断相比，反映当前IDSA指南和机构特定抗菌谱的医嘱集显示出相似的抗生素选择合理率。医生对SSTI管理的认知可能是本研究的一个局限。
