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阿联酋阿布扎比一家综合医院的抗生素管理计划:应对新冠疫情的准备工作

Antibiotic Stewardship Program in a General Hospital in Abu Dhabi, UAE: Preparedness for the COVID-19 Pandemic.

作者信息

Vats Kanika, Singh Kuldeep, Oommen Seema

机构信息

Department of Research and Development, Healthcare Technical and Compliance Directorate, Emirates Classification Society (TASNEEF), Abu Dhabi, ARE.

Department of Management, School of Commerce and Management, Om Sterling Global University, Hisar, IND.

出版信息

Cureus. 2024 Aug 20;16(8):e67270. doi: 10.7759/cureus.67270. eCollection 2024 Aug.

Abstract

Introduction The COVID-19 pandemic has highlighted the critical need for resilient healthcare systems capable of swift response and adaptation, particularly in light of the ongoing global threat of antibiotic resistance. Hospitals in Abu Dhabi, UAE, are not exempted and must establish robust antibiotic stewardship programs capable of navigating any pandemic, ensuring judicious antibiotic use while maintaining high standards of care and optimal patient outcomes. This study seeks to evaluate the maturity levels of antibiotic stewardship programs in a general hospital to assess preparedness for such health crises. By analyzing data from non-surgical hospitalized patients in a specific age bracket, the study examines prescribing practices, program efficacy, and the hospital's overall readiness to manage infectious disease outbreaks. The findings will guide efforts to strengthen antibiotic stewardship and improve pandemic readiness across healthcare settings. Methods The retrospective observational study focused on non-surgical hospitalized patients aged 25-40 from January to December 2019. Data were collected from electronic medical records between March 2023 and February 2024, using a predefined set of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes related to respiratory tract infections, urinary tract infections, ventilator-associated pneumonia, and nosocomial infections. The study evaluated clinicians' prescribing habits, antibiotic consumption, stewardship interventions, and the overall impact on the healthcare system to assess the implementation and maturity levels of the antibiotic stewardship program. Results A study of 240 cases involving 229 patients revealed significant findings in antibiotic use and resistance patterns based on predefined criteria. The average duration of antibiotic use per patient was 6.23 days. Duplicate anaerobic therapy was identified in 4.58% of cases. , , spp., and spp. showed reduced susceptibility to multiple antibiotics. spp. were fully resistant to one antibiotic and had low susceptibility to another. , spp., spp., spp., and spp.displayed varying degrees of reduced susceptibility. Of the cases, 91.66% (n = 220) received antibiotics within 24 hours of admission, with 98.63% (n = 217) receiving empirical therapy. Inaccurate empirical decisions correlated with longer hospital stays (4.45 versus 3.36 days). Appropriate antibiotic stewardship was observed in only 2.35% of cases during stays exceeding three days and 16.47% at discharge. Recommendation A further longitudinal study is recommended to compare how these results contribute to our understanding of the impact of the COVID-19 pandemic on antibiotic stewardship practices, resistance trends, and clinicians' prescribing habits in non-surgical hospitals in Abu Dhabi. Conclusion The review highlighted key aspects of existing stewardship practices. While most patients received empirical therapy, issues such as duplicate anaerobic therapy and a concerning decline in antibiotic susceptibility were identified. Inaccurate empirical decisions were associated with longer hospital stays. The limited instances of appropriate stewardship conduct suggest a need for better adherence to antibiotic management practices and enhanced preparedness for future healthcare challenges.

摘要

引言

新冠疫情凸显了建立具备快速响应和适应能力的弹性医疗系统的迫切需求,尤其是鉴于抗生素耐药性这一持续存在的全球威胁。阿联酋阿布扎比的医院也不例外,必须建立强大的抗生素管理计划,以应对任何疫情,确保合理使用抗生素,同时维持高标准的医疗服务和最佳的患者治疗效果。本研究旨在评估一家综合医院抗生素管理计划的成熟度水平,以评估应对此类健康危机的准备情况。通过分析特定年龄组非手术住院患者的数据,该研究考察了处方行为、计划效果以及医院应对传染病爆发的整体准备情况。研究结果将为加强抗生素管理和提高各医疗机构应对疫情的准备工作提供指导。

方法

这项回顾性观察研究聚焦于2019年1月至12月期间年龄在25至40岁的非手术住院患者。2023年3月至2024年2月期间,使用一组预定义的第十版国际疾病分类临床修订版(ICD - 10 - CM)编码,从电子病历中收集与呼吸道感染、尿路感染、呼吸机相关性肺炎和医院感染相关的数据。该研究评估了临床医生的处方习惯、抗生素使用情况、管理干预措施以及对医疗系统的总体影响,以评估抗生素管理计划的实施情况和成熟度水平。

结果

一项涉及229名患者的240例病例研究,基于预定义标准在抗生素使用和耐药模式方面得出了显著结果。每位患者的抗生素平均使用时长为6.23天。在4.58%的病例中发现了重复的厌氧治疗。 、 、 属和 属对多种抗生素的敏感性降低。 属对一种抗生素完全耐药,对另一种抗生素敏感性较低。 属、 属、 属、 属和 属表现出不同程度的敏感性降低。在这些病例中,91.66%(n = 220)在入院后24小时内接受了抗生素治疗,其中98.63%(n = 217)接受了经验性治疗。不准确的经验性决策与更长的住院时间相关(4.45天对3.36天)。在住院超过三天的病例中,仅2.35%观察到了适当的抗生素管理,出院时这一比例为16.47%。

建议

建议进一步开展纵向研究,以比较这些结果如何有助于我们理解新冠疫情对阿布扎比非手术医院抗生素管理实践、耐药趋势和临床医生处方习惯的影响。

结论

该综述突出了现有管理实践的关键方面。虽然大多数患者接受了经验性治疗,但发现了重复厌氧治疗以及令人担忧的抗生素敏感性下降等问题。不准确的经验性决策与更长的住院时间相关。适当管理行为的案例有限,表明需要更好地遵守抗生素管理实践,并加强应对未来医疗挑战的准备工作。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3d8/11411391/0a067fd23be8/cureus-0016-00000067270-i01.jpg

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