Gorgulho Ana, Cunha Flávia, Alves Branco Elsa, Azevedo Ana, Almeida Francisco, Duro Raquel, Andrade Paulo, Rocha Pereira Nuno, Lima Alves Carlos
Internal Medicine Department, Hospital de Cascais, Av. Brigadeiro Victor Novais Gonçalves, 2755-009 Cascais, Portugal.
Infectious Diseases Department, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal.
Antibiotics (Basel). 2023 Feb 1;12(2):288. doi: 10.3390/antibiotics12020288.
Third-generation cephalosporins are widely used due to the convenient spectrum of activity, safety, and posology. However, they are associated with the emergence of multidrug-resistant organisms, which makes them important targets for antimicrobial stewardship interventions. We aimed to assess the appropriateness of empirical prescriptions of ceftriaxone in a tertiary hospital. This cross-sectional study analysed empirical ceftriaxone prescriptions in January and June 2021. Patients under other antimicrobials 48 h before admission were excluded. The quality of ceftriaxone prescription was assessed regarding the initial appropriateness, duration of inappropriate ceftriaxone therapy, and missed opportunities for de-escalation. Of 465 prescriptions, 46.5% were inappropriate. The ceftriaxone prescription was inappropriate in 95.7% of lower respiratory tract infections (LRTI) globally and in nearly 40% of urinary tract infections (UTI) in medical and intensive care departments. Intensive care, internal medicine, and palliative care departments showed the highest number of inappropriate ceftriaxone prescriptions and longer length of inappropriate ceftriaxone prescriptions compared to the hospital's average. Improvement of empirical ceftriaxone prescription in LRTI and urinary infections, adherence to local guidelines and de-escalation practices, and targeted interventions focusing on critical departments may significantly reduce the inappropriate empirical use of ceftriaxone.
第三代头孢菌素因其抗菌谱广、安全性高及给药方便而被广泛应用。然而，它们与多重耐药菌的出现有关，这使得它们成为抗菌药物管理干预的重要目标。我们旨在评估某三级医院头孢曲松经验性处方的合理性。这项横断面研究分析了2021年1月和6月的头孢曲松经验性处方。排除入院前48小时内使用其他抗菌药物的患者。从初始合理性、头孢曲松治疗不当的持续时间以及降阶梯治疗的错失机会等方面评估头孢曲松处方质量。在465份处方中，46.5% 不合理。在所有下呼吸道感染（LRTI）中，95.7% 的头孢曲松处方不合理，在内科和重症监护病房的尿路感染（UTI）中，近40% 的处方不合理。与医院平均水平相比，重症监护病房、内科和姑息治疗科的头孢曲松处方不合理数量最多，且不合理处方的持续时间更长。改善下呼吸道感染和泌尿系统感染中头孢曲松的经验性处方、遵守当地指南和降阶梯治疗措施，以及针对关键科室的针对性干预措施，可能会显著减少头孢曲松的不合理经验性使用。
