Lynch LeeAnne C, Mende Katrin, Hamdy Rana F, Olsen Cara H, Waterman Paige E, Young John M, Tribble David R
Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.
Infect Control Hosp Epidemiol. 2025 Mar 13:1-11. doi: 10.1017/ice.2025.33.
Evaluate Department of Defense (DoD) antimicrobial stewardship programs (ASPs) by assessing the relationship between key clinical outcome metrics (antibiotic use, incidence of resistant pathogens, and incidence of infections) and CDC Core Element (CE) adherence.
Retrospective, cross-sectional study of DoD hospitals in 2018 and 2021.
National Healthcare Safety Network Standardized Antimicrobial Administration Ratios (SAARs) were used to measure antibiotic use and microbiology results to evaluate four types of pathogen incidence. A novel CE scoring approach used scores to quantitatively assess relationships with CE adherence and outcome metrics using correlation and regression models. Assessments were repeated with 2021 data for Priority CE adherence and to conduct adjusted regressions for CEs and Priority CEs controlling for categorical bed size.
Compared to 2022 national data, DoD hospitals in 2021 had a similar proportion of facilities with a SAAR statistically significantly > 1.0. Leadership, Action, and Tracking CEs followed a more normal score distribution, while Reporting and Education were somewhat left-skewed. Unadjusted models often showed a positive relationship with higher CE scores associated with worse outcomes for the SAAR and pathogen incidence. Adjusted models indicated that procedural CEs, particularly Priority Reporting, were associated with better ASP-related outcomes.
CEs should be more quantitatively assessed. Results provide initial evidence to prioritize procedural CE implementation within the DoD; however, additional investigation for structural CEs is needed. Patient outcome data should be collected as an important indicator of ASP performance.
通过评估关键临床结局指标（抗生素使用、耐药病原体发生率和感染发生率）与美国疾病控制与预防中心核心要素（CE）依从性之间的关系，对美国国防部抗菌药物管理计划（ASP）进行评估。
对2018年和2021年美国国防部医院进行回顾性横断面研究。
使用国家医疗安全网络标准化抗菌药物给药率（SAAR）来衡量抗生素使用情况，并利用微生物学结果评估四种病原体发生率。一种新颖的CE评分方法使用分数，通过相关和回归模型定量评估与CE依从性和结局指标的关系。使用2021年数据对优先CE依从性进行重复评估，并对CE和优先CE进行调整回归，以控制分类床位规模。
与2022年国家数据相比，2021年美国国防部医院中SAAR在统计学上显著>1.0的设施比例相似。领导、行动和跟踪CE的得分分布更接近正态分布，而报告和教育则略显左偏。未调整模型通常显示，较高的CE得分与SAAR和病原体发生率的较差结局呈正相关。调整模型表明，程序性CE，特别是优先报告，与更好的ASP相关结局相关。
应更定量地评估CE。研究结果为美国国防部内部优先实施程序性CE提供了初步证据；然而，需要对结构性CE进行进一步调查。应收集患者结局数据作为ASP绩效的重要指标。
