Schenidt Bispo da Silva Stella Caroline, Fachi Mariana Millan, Ricieri Marinei Campos, de Araújo Motta Fábio
Antimicrobial Stewardship Program, Pequeno Príncipe Hospital, Curitiba, PR, Brazil.
Value Management Office, Pequeno Príncipe Hospital, Curitiba, PR, Brazil.
Infect Prev Pract. 2024 Nov 8;6(4):100419. doi: 10.1016/j.infpip.2024.100419. eCollection 2024 Dec.
Care bundles are a recognised strategy to improve treatment. When managed through an Antimicrobial Stewardship Program (ASP) based on the pharmacist-led program model, care bundles can be an effective tool to guide decision making in clinical practice and to improve patient outcomes. This study aimed to evaluate the results of a pharmacist-led ASP which included a care bundle based on clinical outcomes of bacteraemia (SAB) in a paediatric hospital.
A retrospective cohort study with multivariate analysis was conducted in a paediatric hospital in Brazil. The study comprised 120 paediatric patients with a positive blood culture for with occurred between 2014 and 2021 and clinical and laboratory results consistent with infection. The study was classified into two periods: pre-intervention (n=44) and intervention (n=76). A pharmacist-led ASP program with a care bundle was established during the intervention period 2017-2021. The primary outcome assessed was the impact on clinical outcomes, including infection-related mortality and 90-day reinfection rate, both being considered therapeutic failure.
The multivariate analysis demonstrated that the following variables had an impact on primary outcome: infant patients [Odds ratio (OR) 12.998, =0.044]; use of more than three antimicrobial treatment regimens [OR 0.006, =0.017]; intervention period [OR 0.060, =0.034]; bundle item 1 - follow-up blood culture [OR 18.953, =0.049]; bundle item 2 - early source control [OR 0.002, =0.018]; bundle item 4 - de-escalation to oxacillin for methicillin-sensitive [OR 0.041, =0.046].
The pharmacist-led ASP model showed an increase in adherence to the care bundle between the two study periods, with reduced probability of a negative outcome. Furthermore, risk factors for bacteraemia were identified that may inform management and contribute to better patient outcomes in the paediatric population.
护理包是一种公认的改善治疗的策略。当通过基于药剂师主导项目模式的抗菌药物管理计划（ASP）进行管理时，护理包可以成为指导临床实践决策和改善患者预后的有效工具。本研究旨在评估在一家儿科医院中，由药剂师主导的ASP（其中包括基于血流感染（SAB）临床结局的护理包）的效果。
在巴西的一家儿科医院进行了一项多变量分析的回顾性队列研究。该研究包括120例在2014年至2021年期间血培养呈阳性且临床和实验室结果与感染相符的儿科患者。该研究分为两个时期：干预前（n = 44）和干预期（n = 76）。在2017 - 2021年干预期间建立了由药剂师主导的带有护理包的ASP项目。评估的主要结局是对临床结局的影响，包括感染相关死亡率和90天再感染率，这两者均被视为治疗失败。
多变量分析表明，以下变量对主要结局有影响：婴儿患者[比值比（OR）12.998，P = 0.044]；使用超过三种抗菌治疗方案[OR 0.006，P = 0.017]；干预期[OR 0.060，P = 0.034]；护理包项目1 - 后续血培养[OR 18.953，P = 0.049]；护理包项目2 - 早期源头控制[OR 0.002，P = 0.018]；护理包项目4 - 对甲氧西林敏感菌降阶梯使用苯唑西林[OR 0.041，P = 0.046]。
在两个研究时期之间，由药剂师主导的ASP模式显示出对护理包的依从性增加，负面结局的可能性降低。此外，还确定了血流感染的危险因素，这可能为儿科人群的管理提供参考并有助于改善患者预后。
