Infectious Diseases Telehealth Services, Intermountain Healthcare, Murray, Utah, USA.
Department of Pharmacy, Intermountain Medical Center, Murray, Utah, USA.
J Hosp Med. 2023 Aug;18(8):719-723. doi: 10.1002/jhm.13118. Epub 2023 May 1.
Antibiotic stewardship interventions are urgently needed to reduce antibiotic overuse in hospitalized COVID-19 patients, particularly in small community hospitals (SCHs), who often lack access to infectious diseases (ID) and stewardship resources. We implemented multidisciplinary tele-COVID rounds plus tele-antibiotic stewardship surveillance in 17 SCHs to standardize COVID management and evaluate concurrent antibiotics for discontinuation. Antibiotic use was compared in the 4 months preintervention versus 10 months postintervention. Interrupted time-series analysis demonstrated an immediate decrease in antibiotic use by 339 days of therapy/1000 COVID-19 patient days (p < .001), and an estimated 5258 antibiotic days avoided during the postintervention period. Thirty-day mortality was not significantly different, and a significant reduction in transfers was observed following the intervention (23.3% vs. 7.8%, p < .001). A novel tele-ID and tele-stewardship intervention significantly decreased antibiotic use and transfers among COVID-19 patients at 17 SCHs, demonstrating that telehealth is a feasible way to provide ID expertise in community and rural settings.
抗生素管理干预措施迫切需要减少住院 COVID-19 患者的抗生素过度使用，特别是在缺乏传染病（ID）和管理资源的小型社区医院（SCH）。我们在 17 家 SCH 实施了多学科远程 COVID 查房加远程抗生素管理监测，以规范 COVID 管理并评估同时使用的抗生素是否可以停用。在干预前的 4 个月和干预后的 10 个月比较了抗生素的使用情况。中断时间序列分析显示，抗生素使用立即减少了 339 天的治疗/1000 COVID-19 患者天（p <.001），估计在干预后期间避免了 5258 天的抗生素治疗。30 天死亡率没有显著差异，干预后观察到转院明显减少（23.3%比 7.8%，p <.001）。一项新的远程 ID 和远程管理干预措施显著减少了 17 家 SCH 的 COVID-19 患者的抗生素使用和转院，表明远程医疗是在社区和农村地区提供 ID 专业知识的一种可行方式。
