Shubeilat Jamilah L, Ilges Dan, Ton Angie N, Seville Maria Teresa A
Division of Infectious Diseases, Mayo Clinic, Phoenix, Arizona, USA.
Department of Pharmacy Services, Mayo Clinic, Phoenix, Arizona, USA.
Antimicrob Steward Healthc Epidemiol. 2024 Apr 29;4(1):e63. doi: 10.1017/ash.2024.56. eCollection 2024.
Prescribing of antibiotics for viral upper respiratory infections (URIs) remains a pressing public health problem. We sought to reduce inappropriate prescribing of antibiotics for URIs in Mayo Clinic Arizona.
Single-center, quasi-experimental, and retrospective cohort study.
Emergency medicine and all primary care departments.
The interventions included sharing baseline prescribing data, education, resources, and quarterly peer comparison reports. Encounters with diagnostic codes for respiratory infections commonly caused by viruses were categorized as Tier 3 (ie, never appropriate to prescribe antibiotics). Our goal was to reduce inappropriate prescribing for Tier 3 encounters by 22% in 2022.
Department education was completed by June 2022. The annual antibiotic prescribing rate for Tier 3 encounters was reduced by 29%, from a baseline rate of 23.6% in 2021 to 16.4% in 2022 ( < .001). The posteducation prescribing rate was 13.1%. Repeat respiratory-related healthcare contact within 14 days of Tier 3 encounters did not differ between patients prescribed and not prescribed an antibiotic in all of 2022 (4.7% antibiotic vs 4.2% no antibiotic, = .595) or during the posteducation period (3.7% vs 4.6%, = .604).
A multi-faceted intervention, which included baseline education, syndrome-specific order panels, resources for symptomatic management, and peer comparison reports, resulted in significant reduction of inappropriate antibiotic prescribing for URIs.
针对病毒性上呼吸道感染（URI）开具抗生素处方仍是一个紧迫的公共卫生问题。我们试图在亚利桑那州梅奥诊所减少URI抗生素的不恰当处方。
单中心、准实验性回顾性队列研究。
急诊医学科和所有初级保健科室。
干预措施包括共享基线处方数据、开展教育、提供资源以及每季度的同行比较报告。将诊断编码为常见病毒引起的呼吸道感染的就诊归类为3级（即绝不适合开具抗生素）。我们的目标是在2022年将3级就诊的不恰当处方减少22%。
科室教育于2022年6月完成。3级就诊的年度抗生素处方率降低了29%，从2021年的基线率23.6%降至2022年的16.4%（P<0.001）。教育后的处方率为13.1%。在2022年全年，3级就诊后14天内再次进行呼吸道相关医疗接触的情况，在开具抗生素和未开具抗生素的患者之间没有差异（开具抗生素组为4.7%，未开具抗生素组为4.2%，P = 0.595），在教育后阶段也是如此（分别为3.7%和4.6%，P = 0.604）。
多方面干预措施，包括基线教育、特定综合征医嘱模板、对症治疗资源以及同行比较报告，显著减少了URI抗生素的不恰当处方。
