Infectious Diseases Unit, Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy.
Department of Emergency and Critical Care, "Santa Maria Delle Grazie Hospital", Pozzuoli, Italy.
Intern Emerg Med. 2024 Mar;19(2):493-500. doi: 10.1007/s11739-023-03418-1. Epub 2023 Sep 12.
Evidence supporting the effectiveness of Antimicrobial Stewardship (AMS) Programs in the emergency department (ED) setting is limited. We conducted a prospective cohort study to assess the efficacy of an AMS program in an ED and a short-stay observation unit. The intervention included periodic prospective audits (twice a week), conducted by four infectious disease consultants. Primary outcomes included the difference in the hospital mortality rate, antibiotic consumption, and the incidence of bloodstream infections (BSI) caused by multidrug resistant (MDR) bacteria, before March 2020-February 2021 and after March 2021-February 2022 when the program was implemented. Interrupted time-series analysis was performed to assess the effect of our program. During the 12-month program, we performed 152 audits and evaluated 366 antibiotic therapies out of a total of 853 patients admitted. In the intervention period, we observed a non-statistically significant decrease in total antibiotic consumption, with a change in level of - 31.2 defined daily dose/100 patient-days (PD) (p = 0.71). Likewise, we found no significant variations in the rate of BSI due to MDR Gram-positive (CT - 0.02 events/PD, p = 0.84), MDR Gram-negative bacteria (CT 0.08, p = 0.71), or Candida spp. (CT 0.008, p = 0.86). Conversely, we found a significant decrease in the mortality rate between the pre- and post-intervention periods (- 1.98 deaths/100 PD, CI - 3.9 to - 0.007, p = 0.049). The Antibiotic Stewardship Program in the ED was associated with a significant decrease in the mortality rate. More high-quality studies are needed to determine the most effective ASP strategies in this unique setting.
支持在急诊（ED）环境中实施抗菌药物管理（AMS）计划的有效性的证据有限。我们进行了一项前瞻性队列研究，以评估 ED 和短期观察单位中 AMS 计划的疗效。该干预措施包括由四名传染病顾问进行定期前瞻性审核（每周两次）。主要结局包括在实施该计划之前的 2020 年 3 月至 2021 年 2 月和之后的 2021 年 3 月至 2022 年 2 月期间，医院死亡率、抗生素消耗以及由耐多药（MDR）细菌引起的血流感染（BSI）的发生率的差异。采用中断时间序列分析来评估我们方案的效果。在为期 12 个月的方案中，我们共进行了 152 次审核，评估了 853 名入院患者中的 366 种抗生素治疗方案。在干预期间，我们观察到总抗生素消耗呈非统计学显著下降，水平变化为 -31.2 定义日剂量/100 患者日（PD）（p=0.71）。同样，我们发现 MDR 革兰阳性菌（CT-0.02 事件/PD，p=0.84）、MDR 革兰阴性菌（CT0.08，p=0.71）或念珠菌属（CT0.008，p=0.86）所致 BSI 发生率无显著变化。相反，我们发现干预前后死亡率有显著下降（-1.98 例死亡/100 PD，CI-3.9 至-0.007，p=0.049）。ED 中的抗生素管理计划与死亡率的显著下降有关。需要更多高质量的研究来确定在这种独特环境中最有效的 ASP 策略。
