Hurtado Daniel, Varela Mario, Juarez Alejandra, Nguyen Y-Nha, Nhean Salin
Valley Baptist Medical Center, Brownsville, TX, USA.
Kingman Regional Medical Center, Kingman, AZ, USA.
Hosp Pharm. 2023 Oct;58(5):491-495. doi: 10.1177/00185787231160436. Epub 2023 Mar 16.
Inappropriate antibiotic use is a major public health concern. Excessive exposure to antibiotics results in the proliferation of multidrug-resistant bacteria, increase in potentially avoidable adverse drug reactions, healthcare utilization, and cost. Currently, systematic reviews and controlled trials assessing the effects of antimicrobial stewardship programs (ASP) on hospital length of stay (LOS), mortality, and cost-savings are conflicting. Some studies reported a significant cost-savings driven by shorter hospital LOS while the others found no effect and, in some cases, prolonged LOS. Shortening the time to appropriate therapy and reducing unnecessary days of therapy have been shown to reduce hospital LOS. The purpose of this study was to evaluate the effects of prescriber acceptance to ASP interventions on hospital LOS. Between January 2018 and December 2019, 764 charts were retrospectively reviewed for patients who received antimicrobial treatment and in whom an ASP intervention was performed. Patients were allocated into 2 groups: those whose ASP interventions were accepted and those whose were rejected. Provider responses were then documented within 24 hours of being communicated. The primary outcome was hospital LOS. Secondary outcomes included 30-day readmission rates and inpatient antimicrobial duration of therapy (DOT). There were 384 patients with an accepted ASP intervention and 380 with a denied intervention. Baseline characteristics were similar between both groups, except for a difference in the types of intervention performed ( < 0.001). The median hospital LOS for patients in the accepted intervention group was 6.5 days compared to 7 days in the rejected intervention group ( = 0.009). Antimicrobial DOT was also shorter in the accepted intervention group (5 vs 7 days; < 0.001). There was no difference in 30-day readmission rates ( = 0.98). Prescriber acceptance to ASP interventions decreases hospital LOS and antimicrobial DOT without affecting 30-day readmission rates.
不恰当使用抗生素是一个重大的公共卫生问题。过度接触抗生素会导致多重耐药菌的增殖，增加潜在可避免的药物不良反应、医疗保健利用率和成本。目前，评估抗菌药物管理计划（ASP）对住院时间（LOS）、死亡率和成本节约影响的系统评价和对照试验结果相互矛盾。一些研究报告称，住院时间缩短带来了显著的成本节约，而另一些研究则未发现效果，在某些情况下，甚至住院时间延长。缩短获得恰当治疗的时间并减少不必要的治疗天数已被证明可缩短住院时间。本研究的目的是评估开处方者接受ASP干预对住院时间的影响。在2018年1月至2019年12月期间，对764例接受抗菌治疗且进行了ASP干预的患者病历进行回顾性分析。患者被分为两组：接受ASP干预的患者和拒绝ASP干预的患者。然后在沟通后的24小时内记录医护人员的回应。主要结局是住院时间。次要结局包括30天再入院率和住院患者抗菌药物治疗疗程（DOT）。有384例患者接受了ASP干预，380例患者拒绝了干预。两组的基线特征相似，但所进行的干预类型存在差异（<0.001）。接受干预组患者的住院时间中位数为6.5天，而拒绝干预组为7天（=0.009）。接受干预组的抗菌药物DOT也较短（5天对7天；<0.001）。30天再入院率没有差异（=0.98）。开处方者接受ASP干预可缩短住院时间和抗菌药物DOT，且不影响30天再入院率。
