Amin Alpesh N, Dellinger E Patchen, Harnett Glenn, Kraft Bryan D, LaPlante Kerry L, LoVecchio Frank, McKinnell James A, Tillotson Glenn, Valentine Salisia
Department of Medicine, University of California, Irvine, Irvine, CA, United States.
Department of Surgery, University of Washington, Seattle, WA, United States.
Front Med (Lausanne). 2022 Jul 27;9:901980. doi: 10.3389/fmed.2022.901980. eCollection 2022.
Antibiotic-resistant pathogens cause over 35,000 preventable deaths in the United States every year, and multiple strategies could decrease morbidity and mortality. As antibiotic stewardship requirements are being deployed for the outpatient setting, community providers are facing systematic challenges in implementing stewardship programs. Given that the vast majority of antibiotics are prescribed in the outpatient setting, there are endless opportunities to make a smart and informed choice when prescribing and to move the needle on antibiotic stewardship. Antibiotic stewardship in the community, or "smart prescribing" as we suggest, should factor in antibiotic efficacy, safety, local resistance rates, and overall cost, in addition to patient-specific factors and disease presentation, to arrive at an appropriate therapy. Here, we discuss some of the challenges, such as patient/parent pressure to prescribe, lack of data or resources for implementation, and a disconnect between guidelines and real-world practice, among others. We have assembled an easy-to-use best practice guide for providers in the outpatient setting who lack the time or resources to develop a plan or consult lengthy guidelines. We provide specific suggestions for antibiotic prescribing that align real-world clinical practice with best practices for antibiotic stewardship for two of the most common bacterial infections seen in the outpatient setting: community-acquired pneumonia and skin and soft-tissue infection. In addition, we discuss many ways that community providers, payors, and regulatory bodies can make antibiotic stewardship easier to implement and more streamlined in the outpatient setting.
在美国，抗生素耐药性病原体每年导致超过35000例可预防的死亡，多种策略可降低发病率和死亡率。随着门诊环境中抗生素管理要求的实施，社区医疗服务提供者在实施管理计划时面临系统性挑战。鉴于绝大多数抗生素是在门诊环境中开具的，在开处方时做出明智且有依据的选择以及推动抗生素管理工作有无数的机会。社区抗生素管理，即我们所建议的“明智处方”，除了考虑患者特定因素和疾病表现外，还应将抗生素疗效、安全性、当地耐药率和总体成本纳入考量，以得出合适的治疗方案。在此，我们讨论一些挑战，比如患者/家长要求开处方的压力、实施缺乏数据或资源，以及指南与实际临床实践脱节等。我们为门诊环境中缺乏时间或资源来制定计划或查阅冗长指南的医疗服务提供者汇编了一份易于使用的最佳实践指南。我们针对门诊环境中最常见的两种细菌感染——社区获得性肺炎和皮肤及软组织感染，提供了抗生素处方的具体建议，使实际临床实践与抗生素管理的最佳实践保持一致。此外，我们还讨论了社区医疗服务提供者、支付方和监管机构可以采取的多种方式，以便在门诊环境中更轻松地实施抗生素管理并使其更加简化。
