Otake Shogo, Kusama Yoshiki, Tsuzuki Shinya, Myojin Shota, Kimura Makoto, Kamiyoshi Naohiro, Takumi Toru, Ishida Akihito, Kasai Masashi
Division of Infectious Disease, Department of Pediatrics, Kobe Children's Hospital, Kobe, Hyogo, Japan.
Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan.
Pediatr Int. 2023 Jan-Dec;65(1):e15614. doi: 10.1111/ped.15614.
Antimicrobial prescription rates tend to be high in outpatient settings and Primary Emergency Medical Centers (PECs) in Japan encounter difficulties in implementing antimicrobial stewardship programs (ASPs). While a nudge-based ASP publishing monthly newsletters reduces inappropriate prescription of oral third-generation cephalosporins (3GCs), which requires considerable effort. Therefore, developing more preferable ASP models in PECs is essential.
We conducted a three-center, retrospective observational study. Himeji City Emergency Medical Center (Site A) introduced a facility-specific guideline for antimicrobial stewardship with reference to national guidelines. The Kobe Children's Primary Emergency Medical Center (Site B) provided the results of monitoring antibiotics prescription in a monthly newsletter. The Hanshin-Kita Children's First-Aid Center (Site C) did not perform a specific ASP. Prescription rates for 3GCs were categorized into pre- and post-intervention and compared using Poisson regression analysis. The difference-in-difference method was used to assess the effect of these interventions.
The numbers of patients pre- and post- intervention were 177,126 and 91,251, respectively. The 3GCs prescription rate at Site A, Site B, and Site C decreased from 6.7%, 4.2%, and 6.1% in 2016 to 2.3%, 1.0%, and 2.0% in 2019, respectively. Site B had a greater reduction than Site A and Site C (relative risk [RR] 0.71 [95% confidence interval (CI): 0.62-0.82]; p < 0.001, RR 0.71, [95% CI: 0.62-0.81]; p < 0.001). There was no significant difference between Site A and Site C (RR 1.00 [95% CI 0.88-1.13]; p = 0.963).
A facility-specific guideline was less effective than a nudge-based ASP for decreasing oral 3GC prescriptions in PECs.
在日本，门诊环境中的抗菌药物处方率往往较高，初级急救医疗中心（PEC）在实施抗菌药物管理计划（ASP）时遇到困难。虽然基于助推的ASP通过每月发布时事通讯减少了口服第三代头孢菌素（3GC）的不适当处方，但这需要付出相当大的努力。因此，在PEC中开发更合适的ASP模式至关重要。
我们进行了一项三中心回顾性观察研究。姬路市急救医疗中心（A点）参照国家指南引入了针对特定机构的抗菌药物管理指南。神户儿童初级急救医疗中心（B点）在每月时事通讯中公布抗生素处方监测结果。阪神北儿童急救中心（C点）未实施特定的ASP。将3GC的处方率分为干预前和干预后，并使用泊松回归分析进行比较。采用差异法评估这些干预措施的效果。
干预前后的患者人数分别为177,126人和91,251人。A点、B点和C点的3GC处方率分别从2016年的6.7%、4.2%和6.1%降至2019年的2.3%、1.0%和2.0%。B点的降幅大于A点和C点（相对风险[RR]0.71[95%置信区间（CI）：0.62 - 0.82]；p < 0.001，RR 0.71，[95% CI：0.62 - 0.81]；p < 0.001）。A点和C点之间无显著差异（RR 1.00[95% CI 0.88 - 1.13]；p = 0.963）。
在PEC中，针对特定机构的指南在减少口服3GC处方方面不如基于助推的ASP有效。
