药剂师和感染控制团队或抗菌药物管理团队对万古霉素安全性和有效性的影响：一项日本行政索赔数据库研究。
Influence of pharmacists and infection control teams or antimicrobial stewardship teams on the safety and efficacy of vancomycin: A Japanese administrative claims database study.
机构信息
Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto, Japan.
Division of General Pediatrics, Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan.
出版信息
PLoS One. 2022 Sep 9;17(9):e0274324. doi: 10.1371/journal.pone.0274324. eCollection 2022.
INTRODUCTION
Methicillin-resistant Staphylococcus aureus (MRSA) has a high mortality and requires effective treatment with anti-MRSA agents such as vancomycin (VCM). Management of the efficacy and safety of VCM has been implemented with the assignment of pharmacists in hospital wards and the establishment of teams related to infectious diseases. However, there are no reports evaluating the association between these factors and the efficacy and safety of VCM in large populations.
METHODS
This study used the Japanese administrative claims database accumulated from 2010 to 2019. The population was divided into two groups, therapeutic drug monitoring (TDM) group and non-TDM group, and adjusted by propensity score matching. We performed multivariate logistic regression analysis to determine the influence of pharmacists and infection control teams or antimicrobial stewardship teams on acute kidney injury (AKI) and 30-day mortality.
RESULTS
The total number of patients was 73 478 (TDM group, n = 55 269; non-TDM group, n = 18 209). After propensity score matching, 18 196 patients were matched in each group. Multivariate logistic regression analysis showed that pharmacological management for each patient contributed to the reduction of AKI (odds ratio [OR]: 0.812, 95% confidence interval [CI]: 0.723‒0.912) and 30-day mortality (OR: 0.538, 95% CI: 0.503‒0.575). However, the establishment of infectious disease associated team in facilities and the assignment of pharmacists in the hospital wards had no effect on AKI and 30-day mortality. In addition, TDM did not affect the reduction in AKI (OR: 1.061, 95% CI: 0.948‒1.187), but reduced 30-day mortality (OR: 0.873, 95% CI: 0.821‒0.929).
CONCLUSION
Pharmacologic management for individual patients, rather than assignment systems at facilities, is effective to reduce AKI and 30-day mortality with VCM administration.
简介
耐甲氧西林金黄色葡萄球菌（MRSA）死亡率高，需要使用万古霉素（VCM）等抗 MRSA 药物进行有效治疗。在医院病房分配药剂师和建立与传染病相关的团队，已经实施了万古霉素疗效和安全性的管理。然而，目前尚无关于这些因素与大人群中 VCM 的疗效和安全性之间的关联的报告。
方法
本研究使用了从 2010 年到 2019 年积累的日本行政索赔数据库。人群分为治疗药物监测（TDM）组和非 TDM 组，并通过倾向评分匹配进行调整。我们进行了多变量逻辑回归分析，以确定药剂师和感染控制团队或抗菌药物管理团队对急性肾损伤（AKI）和 30 天死亡率的影响。
结果
总共有 73478 名患者（TDM 组，n=55269；非 TDM 组，n=18209）。经过倾向评分匹配后，每组匹配了 18196 名患者。多变量逻辑回归分析表明，每位患者的药物治疗管理有助于降低 AKI（比值比[OR]：0.812，95%置信区间[CI]：0.723-0.912）和 30 天死亡率（OR：0.538，95%CI：0.503-0.575）。然而，医疗机构中感染病相关团队的建立以及医院病房中药剂师的分配对 AKI 和 30 天死亡率没有影响。此外，TDM 并不影响 AKI 的降低（OR：1.061，95%CI：0.948-1.187），但降低了 30 天死亡率（OR：0.873，95%CI：0.821-0.929）。
结论
对个体患者的药物治疗管理，而不是医疗机构的分配系统，是降低 VCM 治疗时 AKI 和 30 天死亡率的有效方法。
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