一项旨在提高七个非重症监护病房抗生素处方质量的前瞻性整群试验。
A prospective cluster trial to increase antibiotic prescription quality in seven non-ICU wards.
作者信息
Scheithauer Simone, Karasimos Britta, Manamayil David, Häfner Helga, Lewalter Karl, Mischke Karl, Heintz Bernhard, Tacke Frank, Brücken David, Lüring Christian, Heidenhain Christoph, Tewarie Lachmandath, Hilgers Ralf-Dieter, Lemmen Sebastian W
机构信息
Department of Infection Control and Infectious Diseases, University Medical Center Göttingen (UMG), Georg-August University Göttingen, Germany.
Clinic for Orthopedics and Trauma Surgery, Hospital Düren, Düren, Germany.
出版信息
GMS Hyg Infect Control. 2023 Jun 5;18:Doc14. doi: 10.3205/dgkh000440. eCollection 2023.
AIM
To evaluate general shortcomings and faculty-specific pitfalls as well as to improve antibiotic prescription quality (ABQ) in non-ICU wards, we performed a prospective cluster trial.
METHODS
An infectious-disease (ID) consulting service performed a prospective investigation consisting of three 12-week phases with point prevalence evaluation conducted once per week (=36 evaluations in total) at seven non-ICU wards, followed by assessment of sustainability (weeks 37-48). Baseline evaluation (phase 1) defined multifaceted interventions by identifying the main shortcomings. Then, to distinguish intervention from time effects, the interventions were performed in four wards, and the 3 remaining wards served as controls; after assessing effects (phase 2), the same interventions were performed in the remaining wards to test the generalizability of the interventions (phase 3). The prolonged responses after all interventions were then analyzed in phase 4. ABQ was evaluated by at least two ID specialists who assessed the indication for therapy, the adherence to the hospital guidelines for empirical therapy, and the overall antibiotic prescription quality.
RESULTS
In phase 1, 406 of 659 (62%) patients cases were adequately treated with antibiotics; the main reason for inappropriate prescription was the lack of an indication (107/253; 42%). The antibiotic prescription quality (ABQ) significantly increased, reaching 86% in all wards after the focused interventions (502/584; nDf=3, ddf=1,697, F=6.9, p=0.0001). In phase 2 the effect was only seen in wards that already participated in interventions (248/347; 71%). No improvement was seen in wards that received interventions only after phase 2 (189/295; 64%). A given indication significantly increased from about 80% to more than 90% (p<.0001). No carryover effects were observed.
DISCUSSION
ABQ can be improved significantly by intervention bundles with apparent sustainable effects.
目的
为评估非重症监护病房的常见不足、特定科室的问题以及提高抗生素处方质量（ABQ），我们开展了一项前瞻性整群试验。
方法
传染病（ID）咨询服务部门进行了一项前瞻性调查，该调查包括三个为期12周的阶段，在七个非重症监护病房每周进行一次时点患病率评估（共36次评估），随后评估可持续性（第37 - 48周）。基线评估（第1阶段）通过识别主要不足来确定多方面干预措施。然后，为区分干预效果与时间效应，在四个病房实施干预措施，其余三个病房作为对照；在评估效果（第2阶段）后，在其余病房实施相同干预措施以测试干预措施的普遍性（第3阶段）。然后在第4阶段分析所有干预措施后的长期反应。由至少两名ID专家评估ABQ，他们评估治疗指征、对医院经验性治疗指南的遵循情况以及总体抗生素处方质量。
结果
在第1阶段，659例患者中有406例（62%）接受了适当的抗生素治疗；处方不当的主要原因是缺乏指征（107/253；42%）。经过针对性干预后，所有病房的抗生素处方质量（ABQ）显著提高，达到86%（502/584；nDf = 3，ddf = 1,697，F = 6.9，p = 0.0001）。在第2阶段，仅在已经参与干预的病房中观察到效果（248/347；71%）。在第2阶段之后才接受干预的病房中未观察到改善（189/295；64%）。特定指征从约80%显著增加到超过90%（p <.0001）。未观察到遗留效应。
讨论
通过具有明显可持续效果的干预组合可显著提高ABQ。
Zotero 插件