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本帖最后由 蓝鱼o_0 于 2012-7-1 22:39 编辑
（1）题目：A Call to Arms: The Imperative for Antimicrobial Stewardship
文献出处：Clinical Infectious Diseases 2011;53(S1):S4–S7
Antimicrobial resistance is a major public health crisis. The prevalence of drug-resistant organisms, such as
the emerging NAP1 strain of Clostridium difficile, now highly resistant to fluoroquinolones, Acinetobacter
species, Klebsiella pneumoniae carbapenemase-producing organisms, and methicillin-resistant Staphylococcus
aureus, is increasing nationwide. The sources of antimicrobial resistance are manifold, but there is a welldocumented
causal relationship between antimicrobial use and misuse and the emergence of antimicrobialresistant
pathogens. As the development of new antimicrobial agents is on the decline, the medical community,
across all specialties and in conjunction with public health services, must develop and implement programs and
strategies designed to preserve the integrity and effectiveness of the existing antimicrobial armamentarium.
Such strategies are collectively known as antimicrobial stewardship programs and have the potential to
minimize the emergence of resistant pathogens.
（2）题目：Need and Potential of Antimicrobial Stewardship in Community Hospitals
出处：Clinical Infectious Diseases 2011;53(S1):S8–S14
摘要
Preventing, reducing, and controlling the emergence of antimicrobial-resistant organisms is a major public
health challenge requiring the participation of the entire medical community and public health agencies.
Antimicrobial stewardship programs (ASPs) have the potential to integrate the many and sometimes disparate
individuals and organizations that rely on antimicrobial agents in an effort to better control antimicrobial
prescribing, possibly minimizing the emergence of resistant organisms. Developing and implementing ASPs can
be a major challenge for community-based hospitals. In addition to specific and localized patterns of
resistance—a consideration for every hospital—community hospitals must develop strategies that appropriately
conform to their size, staffing, personnel, and infrastructure. This article reviews the ASP strategies and resources
currently available to community hospitals for improving if, when, and how antimicrobial agents are prescribed
and delivered.
（3）题目：Strategies for Improving Antimicrobial Use and the Role of Antimicrobial Stewardship Programs
出处：Clinical Infectious Diseases 2011;53(S1):S15–S22
【摘要】
To evaluate the quality of patient care in specific disease states, the Centers for Medicare and Medicaid Services
(CMS) tracks hospital adherence to specific evidencebased performance measures. The performance measures
are processes of care for which there is a strong link between the process and patient outcomes; they provide
objective evaluations of hospital performance and patient care. Currently, CMS supports initiatives in several areas: heart failure, myocardial infarction, community-acquired pneumonia (CAP), and postsurgical complications (through the Surgical Care Improvement Project [SCIP]). CMS performance measures, as well as other quality-improvement initiatives,
work synergistically with antimicrobial stewardship programs (ASPs), which are also strategies for improving drug use and patient care. Like ASPs, core performance strategies, among other goals, promote appropriate antimicrobial selection and use. Thus, performance measures can bolster the influence of ASPs, and ASPs can facilitate the implementation of performance
measures. This article reviews CAP performance measures, SCIP, and strategies for genitourinary infections, and their intersection with ASPs.
（4）题目：Antimicrobial Stewardship Programs in Community Hospitals: The Evidence Base and Case Studies
【出处】Clinical Infectious Diseases 2011;53(S1):S23–S28
【摘要】
By controlling and changing how antimicrobial agents are selected and administered, antimicrobial
stewardship programs (ASPs) aim to prevent or slow the emergence of antimicrobial resistance; optimize the
selection, dosing, and duration of antimicrobial therapy; reduce the incidence of drug-related adverse events;
and lower rates of morbidity and mortality, length of hospitalization, and costs. There is an abundant and
growing body of evidence demonstrating that ASPs change the quantity and quality of antimicrobial
prescriptions; however, measuring whether, when, and how ASPs improve patient outcomes and change
patterns of antimicrobial resistance—which is the ultimate goals of ASPs—has been difficult, but the totality of
evidence indicates that ASPs are capable of achieving these goals. In this article, we review the existing data on
ASPs and their effects on patient care and antimicrobial resistance, as well as strategies for establishing ASPs in
different types of hospitals.
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发表于 2011-10-28 16:48
发表于 2011-10-28 16:56
发表于 2011-10-28 17:07