一项关于干预组合的前瞻性整群随机试验，旨在减少门诊环境中对上呼吸道感染使用不适当抗生素的情况。
A prospective cluster randomized trial of an interventions bundle to reduce inappropriate antibiotic use for upper respiratory tract infections in the outpatient setting.
作者信息
Butt Adeel A, Shams Sherin, Jabeen Atika, Al-Nuaimi Asma Ali, Krishnan Jeyaram Illiayaraja, Malik Aimon B, Saleem Samah, Abdulaziz Maryam Hassan, Seyam Naheel Ismail, Aziz Kamran, Kandil Dalia, Thomas Anil G, Nafady-Hego Hanaa, Lone Muzna I, Al Ajmi Jameela, Bhutta Zain A, AlSulaiti Noora, Hussein Wael E Said, Semaan Sandy, Al-Abdulla Samya Ahmad, Al-Kuwari Mohamed Ghaith, Abou-Samra Abdul-Badi
机构信息
Corporate Quality and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar.
Department of Medicine, Hackensack Meridian Health Network, Edison, NJ, USA.
出版信息
BMC Infect Dis. 2025 Jul 1;25(1):818. doi: 10.1186/s12879-025-11210-z.
BACKGROUND
Antibiotic overuse and increasing antimicrobial resistance are global public health threats. We determined the impact of a multicomponent intervention in reducing inappropriate antibiotic use for upper respiratory tract infections (URTIs) in the outpatient setting.
METHODS
DESIGN: Prospective, cluster-randomized trial.
INTERVENTION
Bundled 4-component intervention including extensive provider education, a decision support algorithm, option for deferred antibiotics prescription, and monthly feedback on prescription patterns, vs. a single randomly assigned intervention (decision support algorithm).
SETTING
Four Primary healthcare centers in Qatar with study period from August 2023 to October 2024.
PARTICIPANTS
Individuals with a diagnosis of URTI who were prescribed antibiotics.
MAIN OUTCOME(S): Reduction in inappropriate antibiotic prescriptions for URTIs in the intervention vs. control group during the 11-month follow-up period.
RESULTS
We analyzed 20,062 episodes-of-care for URTIs with an antibiotic prescription (9,277 at control and 10,785 at intervention sites). In a mixed effects logistic regression model accounting for the clustering effect, the intervention was associated with a 29% reduction in odds of inappropriate antibiotics prescriptions ( [aOR] 0.71; 95% CI 0.66-0.77). The relative reduction was 20.9% (44.9% vs. 35.5%; p < 0.001) between the two groups. The relative drop in inappropriate antibiotic prescriptions before and after the interventions was 16.3% (42.4% vs 35.5%; p < 0.001) at intervention sites (p < 0.001) compared with 2.2% (45.9% to 44.9%; p = 0.4) at control sites. Senior-most physicians and younger population (19-40 years old) were more likely to prescribe or receive inappropriate antibiotic prescription.
CONCLUSION
A multi-component intervention can significantly reduce inappropriate antibiotic prescriptions for URTIs in the outpatient setting.
GOV ID
NCT06135376, Registration Date: November 9, 2023.
背景
抗生素的过度使用以及日益增加的抗菌药物耐药性是全球公共卫生威胁。我们确定了一项多组分干预措施对减少门诊环境中治疗上呼吸道感染（URTIs）时不适当使用抗生素的影响。
方法
设计：前瞻性整群随机试验。
干预措施
包含四个组分的综合干预措施，包括对医疗服务提供者进行广泛教育、采用决策支持算法、提供延迟开具抗生素处方的选项以及每月提供处方模式反馈，与单一随机分配的干预措施（决策支持算法）进行对比。
地点
卡塔尔的四个初级医疗保健中心，研究期为2023年8月至2024年10月。
参与者
被诊断为URTIs且开具了抗生素处方的个体。
主要结局
在11个月的随访期内，干预组与对照组相比，治疗URTIs时不适当抗生素处方的减少情况。
结果
我们分析了20,062例开具抗生素处方的URTIs护理事件（对照组9,277例，干预组10,785例）。在考虑聚类效应的混合效应逻辑回归模型中，干预措施与不适当抗生素处方的几率降低29%相关（调整后比值比[aOR]为0.71；95%置信区间为0.66 - 0.77）。两组之间的相对降低率为20.9%（44.9%对35.5%；p < 0.001）。干预组干预前后不适当抗生素处方的相对降幅为16.3%（42.4%对35.5%；p < 0.001），而对照组为2.2%（45.9%降至44.9%；p = 0.4）（p < 0.001）。最资深的医生和较年轻人群（19 - 40岁）更有可能开具或接受不适当的抗生素处方。
结论
多组分干预措施可显著减少门诊环境中治疗URTIs时不适当的抗生素处方。
政府识别号
NCT06135376，注册日期：2023年11月9日。
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