Borde Kalyani, Medisetty Mahender Kumar, Muppala Baby Shalini, Reddy Aishwarya B, Nosina Sireesha, Dass Manick S, Prashanthi A, Billuri Pushpanjali, Mathai Dilip
Department of Microbiology, Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Road No. 92, Film Nagar, Jubilee Hills, Hyderabad, 500033.
Department of General Medicine, Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Road No. 92, Film Nagar, Jubilee Hills, Hyderabad, 500033.
IJID Reg. 2022 Jun;3:15-20. doi: 10.1016/j.ijregi.2022.02.003. Epub 2022 Feb 7.
There was evidence that antibiotic usage increased in hospitalized COVID-19 patients during the early days of the pandemic.
We assessed the impact of stewardship interventions on antibiotic usage in these patients.
We designed a quasi-experimental study using an interrupted time series. Patients were stratified according to the severity category of the illness - mild and moderate-to-severe (O2 saturation ≥94% and <93% respectively). Baseline antibiotic usage data was collected in the pre-intervention phase. Intervention was given in the form of focus group discussion (FGD) and followed up with feedback-audit during the post-intervention phase. Primary outcome was the change in days of therapy (DOT) per 1000 patient-days.
361 adult patients were recruited in both phases during July to December, 2020. In the post-intervention phase, DOT per 1000 patient-days reduced from 589 to 523 (P=0.013) and from 843 to 585 (P <0.0001) in mild and moderate-to-severe categories, respectively. De-escalations at 48 hours increased significantly from 21% to 41% (P=0.0079) and from 31% to 62% (P=0.0006), respectively. No difference in mortality was observed.
We found high usage of empirical antibiotics in adult patients hospitalized with COVID-19. FGD and feedback audits can successfully reduce antibiotic overuse in these patients.
有证据表明，在疫情早期，住院的新冠肺炎患者抗生素使用量有所增加。
我们评估了管理干预措施对这些患者抗生素使用的影响。
我们采用中断时间序列设计了一项准实验研究。患者根据疾病严重程度分类——轻度和中重度（氧饱和度分别≥94%和<93%）。在干预前阶段收集基线抗生素使用数据。干预采取焦点小组讨论（FGD）的形式，并在干预后阶段进行反馈审核跟进。主要结局是每1000患者日的治疗天数（DOT）变化。
在2020年7月至12月的两个阶段共招募了361名成年患者。在干预后阶段，轻度和中重度患者每1000患者日的DOT分别从589降至523（P=0.013）和从843降至585（P<0.0001）。48小时时的降阶梯使用分别从21%显著增加到41%（P=0.0079）和从31%增加到62%（P=0.0006）。未观察到死亡率有差异。
我们发现新冠肺炎住院成年患者中经验性抗生素使用量较高。焦点小组讨论和反馈审核可成功减少这些患者的抗生素过度使用。
