Suzuki Ayako, Yamaguchi Fumihiro, Maeda Masayuki, Hashiguchi Miyuki, Kabasawa Nobuyuki, Sasaki Jun, Sato Tokutada, Fuyama Masaki, Yamazaki Yohei, Endo Kei, Iwata Kae, Kobayashi Sei, Fujihara Hisato
Department of Pharmacy, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan.
Antimicrobial Stewardship Team, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan.
Antibiotics (Basel). 2023 Feb 2;12(2):302. doi: 10.3390/antibiotics12020302.
As antibiotic resistance has become a global problem, the intervention of an antimicrobial stewardship team (AST) is warranted. In hematological disorders, infectious complications are crucial owing to abnormal neutrophil function and decreased cell-mediated immunity. Despite the widespread implementation of AST intervention, the effectiveness of stewardship practices for immunocompromised patients remains uncertain. We determined the effect of AST interventions on carbapenem therapy in the department of hematology. Patients admitted to the department and undergoing carbapenem therapy were enrolled. We compared carbapenem use between the pre-AST (April 2016-March 2018) and post-AST (April 2018-March 2021) periods. Factors associated with long-term carbapenem therapy were investigated. Overall, 515 episodes of carbapenem therapy in 264 patients in the department were evaluated. According to the interrupted time series analysis, the number of days of therapy decreased with AST intervention (β = -0.263, = 0.011). In multivariate analysis, predictive factors associated with long-term carbapenem therapy (>8 days) were outpatient onset, chronic obstructive pulmonary disease, acute myeloid leukemia, multiple myeloma, and infection with resistant bacteria (such as extended spectrum β-lactamases and AmpC) (95% confidence interval, 1.030-2.818, 1.067-66.667, 1.057-2.782, 0.168-0.742, and 1.382-5.750, respectively). The AST intervention reduced carbapenem use in patients with hematological disorders.
由于抗生素耐药性已成为一个全球性问题，抗菌药物管理团队（AST）的干预很有必要。在血液系统疾病中，由于中性粒细胞功能异常和细胞介导免疫下降，感染性并发症至关重要。尽管AST干预已广泛实施，但针对免疫功能低下患者的管理措施的有效性仍不确定。我们确定了AST干预对血液科碳青霉烯类药物治疗的影响。纳入了入住该科室并接受碳青霉烯类药物治疗的患者。我们比较了AST干预前（2016年4月至2018年3月）和AST干预后（2018年4月至2021年3月）期间碳青霉烯类药物的使用情况。研究了与长期碳青霉烯类药物治疗相关的因素。总体而言，对该科室264例患者的515次碳青霉烯类药物治疗进行了评估。根据中断时间序列分析，AST干预后治疗天数减少（β = -0.263，P = 0.011）。在多变量分析中，与长期碳青霉烯类药物治疗（>8天）相关的预测因素为门诊发病、慢性阻塞性肺疾病、急性髓系白血病、多发性骨髓瘤以及耐细菌感染（如超广谱β-内酰胺酶和AmpC）（95%置信区间分别为1.030 - 2.818、1.067 - 66.667、1.057 - 2.782、0.168 - 0.742和1.382 - 5.750）。AST干预减少了血液系统疾病患者的碳青霉烯类药物使用。
