Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA.
Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Clin Infect Dis. 2022 Dec 19;75(12):2260-2265. doi: 10.1093/cid/ciac598.
Antibiotic resistance is a global public health threat. The use of telehealth in primary care presents unique barriers to antimicrobial stewardship, including limited physical examination and changes to the patient-provider relationship. Since the coronavirus disease 2019 (COVID-19) pandemic, there is a need to identify novel antimicrobial stewardship strategies with an explosion in the use of telehealth within primary care. Our review proposes a tailored, sustainable approach to antimicrobial prescribing in the telehealth setting based on the Centers for Disease Control and Prevention's Core Elements of Outpatient Antibiotic Stewardship: commitment, action for policy and practice; tracking and reporting; and education and expertise. The rapid growth of telehealth for all types of primary care visits (not just antibiotic use) is outpacing knowledge associated with strategies for antimicrobial stewardship. Improving antibiotic use within primary care settings is critical as telehealth will remain a priority whether the COVID-19 pandemic recedes, particularly within patient populations with limited access to healthcare.
抗生素耐药性是一个全球性的公共卫生威胁。远程医疗在初级保健中的应用给抗菌药物管理带来了独特的障碍，包括有限的体检和医患关系的改变。自 2019 年冠状病毒病（COVID-19）大流行以来，需要确定新的抗菌药物管理策略，因为初级保健中远程医疗的使用呈爆炸式增长。我们的综述提出了一种基于疾病控制和预防中心的门诊抗生素管理核心要素：承诺、政策和实践行动；跟踪和报告；以及教育和专业知识，为远程医疗环境中的抗菌药物处方制定了一种量身定制、可持续的方法。各种类型的初级保健就诊（不仅仅是抗生素使用）的远程医疗快速增长，使得与抗菌药物管理策略相关的知识落后。改善初级保健环境中的抗生素使用至关重要，因为无论 COVID-19 大流行是否消退，远程医疗都将是一个优先事项，特别是在那些获得医疗保健机会有限的患者群体中。
