2004 - 2017年威斯康星州综合医疗保健系统中肠道细菌感染的抗菌药物处方实践

Antimicrobial prescribing practices for enteric bacterial infections in an integrated health care system, Wisconsin, 2004-2017.

作者信息

Olson Scott C, Francois Watkins Louise K, Scallan Walter Elaine, Friedman Cindy R, Nguyen Huong Q

机构信息

Marshfield Clinic Research Institute, Marshfield, WI, United States.

Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.

出版信息

J Infect Public Health. 2025 Jan;18(1):102613. doi: 10.1016/j.jiph.2024.102613. Epub 2024 Dec 3.

DOI:10.1016/j.jiph.2024.102613

PMID:39642771

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11875000/

Abstract

BACKGROUND

Few studies have evaluated antibiotic prescribing practices for bacterial enteric infections. Unnecessary antibiotics can result in adverse events and contribute to the emergence of antimicrobial resistance. We assessed treatment practices among patients with laboratory-confirmed enteric infections in a regional healthcare system in Wisconsin, USA.

METHODS

We used electronic health records to identify patients with laboratory-confirmed nontyphoidal Salmonella, Shigella, Shiga toxin-producing Escherichia coli (STEC), and Campylobacter infections during 2004-2017. Relevant clinical data, including diagnosis codes for chronic conditions and receipt of immunosuppressive medications and antibiotic prescriptions, were extracted. We defined appropriate treatment based on pathogen, patient characteristics, and practice guidelines for the study period.

RESULTS

We identified 2064 patients infected with Campylobacter (1251; 61 %), Salmonella (564; 27 %), STEC (199; 10 %), or Shigella (50; 2 %). Overall, 425 (20 %) patients were immunocompromised, ranging from 17 % with Salmonella to 46 % with STEC. There were 220 (11 %) hospitalizations. Antibiotics were prescribed most frequently for Campylobacter (53 %), followed by Shigella (46 %) and Salmonella (44 %) infections. Among those prescribed antibiotics, prescriptions were appropriate for 71 % of Campylobacter, 100 % of Shigella, and 81 % of Salmonella infections. Antibiotics were prescribed for 24 % of STEC infections, despite recommendations against use. Guideline adherence generally decreased with age, except for Shigella infections, where adherence was highest for adults ≥ 50 years.

CONCLUSIONS

Antibiotic prescribing for laboratory-confirmed enteric infections was usually appropriate but did not follow practice guidelines in a substantial minority of cases, presenting opportunity for improvement. Antibiotic stewardship initiatives should address acute bacterial gastrointestinal infections in addition to other common infections.

摘要

背景

很少有研究评估细菌性肠道感染的抗生素处方行为。不必要的抗生素会导致不良事件，并促使抗菌药物耐药性的出现。我们评估了美国威斯康星州一个地区医疗系统中实验室确诊的肠道感染患者的治疗情况。

方法

我们利用电子健康记录识别出2004年至2017年期间实验室确诊的非伤寒沙门氏菌、志贺氏菌、产志贺毒素大肠杆菌（STEC）和弯曲杆菌感染患者。提取了相关临床数据，包括慢性病诊断代码、免疫抑制药物的使用情况和抗生素处方。我们根据病原体、患者特征和研究期间的实践指南确定了适当的治疗方法。

结果

我们识别出2064例感染弯曲杆菌（1251例；61%）、沙门氏菌（564例；27%）、STEC（199例；10%）或志贺氏菌（50例；2%）的患者。总体而言，425例（20%）患者免疫功能低下，沙门氏菌感染患者中这一比例为17%，STEC感染患者中为46%。有220例（11%）患者住院。弯曲杆菌感染患者使用抗生素最为频繁（53%），其次是志贺氏菌感染患者（46%）和沙门氏菌感染患者（44%）。在使用抗生素的患者中，弯曲杆菌感染患者的处方有71%是适当的，志贺氏菌感染患者为100%，沙门氏菌感染患者为81%。尽管有不建议使用抗生素的建议，但仍有24%的STEC感染患者使用了抗生素。除志贺氏菌感染外，指南依从性一般随年龄增长而降低，在≥50岁的成人中，志贺氏菌感染的依从性最高。