Research & Clinical Studies, Medanta Institute of Education and Research (MIER), Gurgaon, Haryana, India.
Division of Infectious Disease, John Hopkins University, School of Medicine, Baltimore, India.
Indian J Med Microbiol. 2023 Sep-Oct;45:100385. doi: 10.1016/j.ijmmb.2023.100385. Epub 2023 Jun 2.
To examine the feasibility of Comprehensive Unit-based Safety Program (CUSP) as a strategy tool to improve antibiotic stewardship in low and middle income countries (LMIC) in resource limited setting. The primary outcome measure is identification of inappropriate prescriptions. The secondary outcome parameters are App adoption trends and antimicrobial prescription pattern and practices.
A prospective quasi-experimental design was used to operationalizing the CUSP intervention. The project considered the data of 482 patients from two mixed Medical ICUs admitted during June 2019 to April 2020. The information was collected on antimicrobials prescription pattern and practices for identification of inappropriate use as well as app adoption trend with respect to Electronic Medical Record (EMR) Orders Placed, Clinical Notes and Checklist Filled. The intervention in the study comprised of development of an antibiotic monitoring stewardship (AMS) data collection app for ease of use and for Clinical Decision Support System (CDSS) to identify the cases of inappropriate use of antibiotics.
Data of patients was reviewed to create algorithms for empirical and directed antibiotic therapy as well as to create a CDSS app. Out of 793 prescriptions initially during July-September 2019, 19 (2.4%) were inappropriate antimicrobial prescription. The continuous monitoring of antimicrobial prescription helped in reducing the irrational use and bring it to level zero at the end.
It requires commitment from the management, and seamless communication within Clinical, Microbiology, Pharmacology and data management teams to create and run a successful CUSP program towards Antimicrobial Resistance. Tools such as the CDSS can smoothen the process.
研究综合单位为基础的安全计划（CUSP）作为一种策略工具在资源有限的中低收入国家（LMIC）改善抗生素管理的可行性。主要观察指标是确定不适当的处方。次要观察指标为 App 的采用趋势以及抗菌药物处方模式和实践。
采用前瞻性准实验设计来实施 CUSP 干预。该项目考虑了 2019 年 6 月至 2020 年 4 月期间入住两个混合内科重症监护病房的 482 名患者的数据。收集抗菌药物处方模式和实践信息，以确定不适当使用的情况，以及电子病历（EMR）医嘱、临床记录和检查表填写方面的 App 采用趋势。研究中的干预措施包括开发一种抗生素监测管理（AMS）数据收集应用程序，以方便使用和建立临床决策支持系统（CDSS）来识别抗生素不适当使用的病例。
对患者数据进行了回顾，以创建用于经验性和靶向抗生素治疗的算法，并创建了一个 CDSS 应用程序。在 2019 年 7 月至 9 月期间最初的 793 份处方中，有 19 份（2.4%）是不适当的抗菌药物处方。对抗菌药物处方的持续监测有助于减少不合理使用，并最终使不合理使用降至零。
需要管理层的承诺，以及临床、微生物学、药理学和数据管理团队之间的无缝沟通，才能创建和运行一个成功的 CUSP 计划，以应对抗生素耐药性。CDSS 等工具可以简化这一过程。
