专业对自我报告的使用口服抗生素疗法确定性治疗血流感染实践的影响。
Impact of specialty on the self-reported practice of using oral antibiotic therapy for definitive treatment of bloodstream infections.
作者信息
Marcelin Jasmine R, Keintz Mackenzie R, Ma Jihyun, Van Schooneveld Trevor C, Alexander Bryan T, Bergman Scott J, Miller Molly M, Stohs Erica J
机构信息
Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska.
Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska.
出版信息
Antimicrob Steward Healthc Epidemiol. 2023 Mar 9;3(1):e48. doi: 10.1017/ash.2023.132. eCollection 2023.
BACKGROUND
No established guidelines exist regarding the role of oral antibiotic therapy (OAT) to treat bloodstream infections (BSIs), and practices may vary depending on clinician specialty and experience.
OBJECTIVE
To assess practice patterns regarding oral antibiotic use for treatment of bacteremia in infectious diseases clinicians (IDCs, including physicians and pharmacists and trainees in these groups) and non-infectious diseases clinicians (NIDCs).
DESIGN
Open-access survey.
PARTICIPANTS
Clinicians caring for hospitalized patients receiving antibiotics.
METHODS
An open-access, web-based survey was distributed to clinicians at a Midwestern academic medical center using e-mail and to clinicians outside the medical center using social media. Respondents answered questions regarding confidence prescribing OAT for BSI in different scenarios. We used χ2 analysis for categorical data evaluated association between responses and demographic groups.
RESULTS
Of 282 survey responses, 82.6% of respondents were physicians, 17.4% pharmacists, and IDCs represented 69.2% of all respondents. IDCs were more likely to select routine use of OAT for BSI due to gram-negative anaerobes (84.6% vs 59.8%; P < .0001), Klebsiella spp (84.5% vs 69.0%; P < .009), Proteus spp (83.6% vs 71.3%; P < .027), and other Enterobacterales (79.5% vs 60.9%; P < .004). Our survey results revealed significant differences in selected treatment of Staphylococcus aureus syndromes. Fewer IDCs than NIDCs selected OAT to complete treatment for methicillin-resistant S. aureus (MRSA) BSI due to gluteal abscess (11.9% vs 25.6%; P = .012) and methicillin-susceptible S. aureus (MSSA) BSI due to septic arthritis (13.9% vs 20.9%; P = .219).
CONCLUSIONS
Practice variation and discordance with evidence for the use of OAT for BSIs exists among IDCs versus NIDCs, highlighting opportunities for education in both clinician groups.
背景
关于口服抗生素疗法（OAT）在治疗血流感染（BSI）中的作用，目前尚无既定指南，其应用可能因临床医生的专业和经验而异。
目的
评估传染病临床医生（IDCs，包括医生、药剂师以及这些群体中的实习生）和非传染病临床医生（NIDCs）在使用口服抗生素治疗菌血症方面的实践模式。
设计
开放式调查。
参与者
负责治疗接受抗生素治疗的住院患者的临床医生。
方法
通过电子邮件向中西部一所学术医疗中心的临床医生以及通过社交媒体向该医疗中心以外的临床医生发放了一份基于网络的开放式调查问卷。受访者回答了关于在不同情况下对BSI开具OAT处方的信心的问题。我们对分类数据使用χ²分析来评估回答与人口统计学组之间的关联。
结果
在282份调查回复中，82.6%的受访者为医生，17.4%为药剂师，IDCs占所有受访者的69.2%。由于革兰氏阴性厌氧菌（84.6%对59.8%；P <.0001）、克雷伯菌属（84.5%对69.0%；P <.009）、变形杆菌属（83.6%对71.3%；P <.027）和其他肠杆菌科细菌（79.5%对60.9%；P <.004），IDCs更有可能选择对BSI常规使用OAT。我们的调查结果显示，在金黄色葡萄球菌综合征的选定治疗方面存在显著差异。因臀肌脓肿导致的耐甲氧西林金黄色葡萄球菌（MRSA）BSI（11.9%对25.6%；P =.012）以及因化脓性关节炎导致的甲氧西林敏感金黄色葡萄球菌（MSSA）BSI（13.9%对20.9%；P =.219），选择OAT完成治疗的IDCs少于NIDCs。
结论
IDCs和NIDCs在使用OAT治疗BSIs方面存在实践差异且与证据不一致，这凸显了对这两个临床医生群体进行教育的机会。
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