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根据国家数据集分析医院相关指标对医疗保健相关感染及抗菌药物使用合理性的影响。

Impact of hospital-related indicators on healthcare-associated infections and appropriateness of antimicrobial use according to a national dataset.

作者信息

Garlasco Jacopo, D'Ambrosio Angelo, Vicentini Costanza, Quattrocolo Francesca, Zotti Carla Maria

机构信息

Department of Public Health Sciences and Paediatrics, University of Turin, Turin, Italy.

Infectious Disease Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.

出版信息

Sci Rep. 2024 Dec 28;14(1):31259. doi: 10.1038/s41598-024-82663-6.

Abstract

Healthcare-associated infections (HAIs) represent a major threat in Europe. Infection prevention and control (IPC) measures are crucial to lower their occurrence, as well as antimicrobial stewardship to ensure appropriate use of antibiotics. Starting from Italian national data, this study aimed at: (i) describing IPC indicators, prevalence of HAIs, antimicrobial use and appropriateness of antibiotic use in Italy; (ii) estimating effects of IPC variables on HAI prevalence and on the proportion of antibiotics without specific reason. Based on data collected for Italy during the ECDC PPS-2 Point Prevalence Survey, descriptive statistics were computed at national and macro-regional level. Causal assumption-informed regression models were then built to estimate the impact of structural determinants, staffing parameters and IPC-related variables on HAI prevalence and percentage of antibiotic prescriptions with no reason detailed on medical records, after adjusting for relevant confounders. The Italian frame showed substantial heterogeneity for both outcomes between macro-regions. The percentage of single-bed rooms was the only structural determinant with significant, positive impact on HAI prevalence (OR = 0.91 for every + 5%, p < 0.001), while the prevalence of antimicrobial agents without specified reason was lower in the presence of one more IPC nurse (OR = 0.78, p < 0.001) or one more antibiotic stewardship consultant (OR = 0.67, p < 0.001) per 100 beds. Both outcomes were reduced in the presence of routinely filed IPC plans and reports (p < 0.001), HAI prevention measures (p < 0.001) and post-prescription review (p < 0.01). Our model confirmed the pivotal role of IPC measures and antimicrobial stewardship in contrasting HAIs and inappropriate antibiotic prescriptions. Post-prescription review appeared to be a valuable indicator of antimicrobial stewardship policies.

摘要

医疗保健相关感染(HAIs)在欧洲构成重大威胁。感染预防与控制(IPC)措施对于降低其发生率至关重要,抗菌药物管理对于确保抗生素的合理使用也同样关键。本研究从意大利国家数据出发,旨在:(i)描述意大利的IPC指标、HAIs患病率、抗菌药物使用情况以及抗生素使用的合理性;(ii)评估IPC变量对HAIs患病率以及无特定原因使用抗生素比例的影响。基于欧洲疾病预防控制中心(ECDC)PPS - 2现患率调查期间收集的意大利数据,在国家和宏观区域层面进行了描述性统计。随后建立了因果假设知情回归模型,以估计在调整相关混杂因素后,结构决定因素、人员配备参数和IPC相关变量对HAIs患病率以及病历中未详细说明理由的抗生素处方百分比的影响。意大利的情况显示,各宏观区域在这两个结果方面存在显著异质性。单人病房的比例是对HAIs患病率有显著正向影响的唯一结构决定因素(每增加5%,OR = 0.91,p < 0.001),而每100张床位多配备一名IPC护士(OR = 0.78,p < 0.001)或一名抗菌药物管理顾问(OR = 0.67,p < 0.001)时,无特定原因使用抗菌药物的患病率较低。在有常规存档的IPC计划和报告(p < 0.001)、HAIs预防措施(p < 0.001)以及处方后审核(p < 0.01)的情况下,这两个结果都会降低。我们的模型证实了IPC措施和抗菌药物管理在对抗HAIs和不适当抗生素处方方面的关键作用。处方后审核似乎是抗菌药物管理政策的一个有价值指标。

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本文引用的文献

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The Impact of a Post-Prescription Review and Feedback Antimicrobial Stewardship Program in Lebanon.
Antibiotics (Basel). 2022 May 11;11(5):642. doi: 10.3390/antibiotics11050642.
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Examining the association between hospital-onset Clostridium difficile infection and multiple-bed room exposure: a case-control study.
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