一项多方面干预措施及其对挪威养老院抗生素使用情况的影响。
A Multifaceted Intervention and Its Effects on Antibiotic Usage in Norwegian Nursing Homes.
作者信息
Harbin Nicolay Jonassen, Haug Jon Birger, Lindbæk Morten, Akselsen Per Espen, Romøren Maria
机构信息
Antibiotic Center for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, 0450 Oslo, Norway.
Department of General Practice Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway.
出版信息
Antibiotics (Basel). 2023 Aug 27;12(9):1372. doi: 10.3390/antibiotics12091372.
We explored the impact of an antibiotic quality improvement intervention across 33 nursing homes (NHs) in one Norwegian county, compared against four control counties. This 12-month multifaceted intervention consisted of three physical conferences, including educational sessions, workshops, antibiotic feedback reports, and academic detailing sessions. We provided clinical guiding checklists to participating NHs. Pharmacy sales data served as a measure of systemic antibiotic use. The primary outcome was a change in antibiotic use in DDD/100 BD from the baseline through the intervention, assessed using linear mixed models to identify changes in antibiotic use. Total antibiotic use decreased by 15.8%, from 8.68 to 7.31 DDD/100BD (model-based estimated change (MBEC): -1.37, 95% CI: -2.35 to -0.41) in the intervention group, albeit not a significantly greater reduction than in the control counties (model-based estimated difference in change (MBEDC): -0.75, 95% CI: -1.91 to 0.41). Oral antibiotic usage for urinary tract infections (UTI-AB) decreased 32.8%, from 4.08 to 2.74 DDD/100BD (MBEC: -1.34, 95% CI: -1.85 to -0.84), a significantly greater reduction than in the control counties (MBEDC: -0.9, 95% CI: -1.28 to -0.31). The multifaceted intervention may reduce UTI-AB use in NHs, whereas adjustments in the implementation strategy may be needed to reduce total antibiotic use.
我们在挪威一个郡的33家养老院中探索了抗生素质量改进干预措施的影响，并与四个对照郡进行了比较。这项为期12个月的多方面干预包括三次实体会议，其中有教育课程、研讨会、抗生素反馈报告和学术指导课程。我们向参与的养老院提供了临床指导清单。药房销售数据用作系统性抗生素使用的衡量指标。主要结果是从基线到干预期间每100床位日限定日剂量（DDD）的抗生素使用变化，使用线性混合模型评估以确定抗生素使用的变化。干预组的总抗生素使用量下降了15.8%，从8.68降至7.31 DDD/100BD（基于模型的估计变化量（MBEC）：-1.37，95%置信区间：-2.35至-0.41），尽管降幅并不比对照郡显著更大（基于模型的变化量估计差异（MBEDC）：-0.75，95%置信区间：-1.91至0.41）。用于治疗尿路感染的口服抗生素使用量（UTI-AB）下降了32.8%，从4.08降至2.74 DDD/100BD（MBEC：-1.34，95%置信区间：-1.85至-0.84），降幅显著大于对照郡（MBEDC：-0.9，95%置信区间：-1.28至-0.31）。多方面干预可能会减少养老院中UTI-AB的使用，而可能需要调整实施策略以减少总抗生素使用量。
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