碳青酶烯类抗菌药管理计划（ASPs）对患者结局的影响

toto

IMPACT OF A CARBAPENEM ANTIMICROBIAL STEWARDSHIP PROGRAM ON PATIENT OUTCOMESABSTRACT

Antimicrobial stewardship programs (ASPs) aim to improve appropriate antimicrobials use. However, concerns of the negative consequences from accepting ASP interventions exist, particularly when de-escalation or discontinuation of broad-spectrum antibiotics are recommended. Hence, we sought to evaluate the impact on clinical outcomes when ASP interventions for inappropriate carbapenem use were accepted or rejected by primary providers.

We retrospectively reviewed all carbapenem prescriptions deemed inappropriate according to institutional guidelines with ASP interventions between July 2011 and December 2014. Intervention acceptance and outcomes including carbapenem utilization, length-of-stay, hospitalization charges, 30-day readmission and mortality rates were reviewed. Data was analyzed in groups where physicians accepted all interventions (“Accepted”) versus rejected (“Rejected”).

A total of 158 ASP interventions were made. These included: carbapenem discontinuation (35%), change to narrower-spectrum antibiotic (32%), dose optimization (17%), further investigations (including imaging, procalcitonin) (11%), Infectious Diseases referral (3%), antibiotic discontinuation (other than carbapenem) (1%) and source control (1%).

Of 220 unique patients, carbapenem use was inappropriate in 101 (45.9%). Significant reduction in carbapenem utilization was observed in the “Accepted” group versus “Rejected” group (median defined daily doses: 0.224 versus 0.668 per 1000 patient-days, p<0.001). There was a significant reduction in 30-day mortality in “Accepted” (none) versus “Rejected” group (10 deaths, p=0.015) but there was no difference in length-of-stay, hospitalization charge and 30-day readmission rates. Hypotension was independently associated with mortality in multivariate analysis (odds ratio, 5.25, 95% confidence interval, 1.34-20.6).

In our institution, acceptance of carbapenem ASP interventions did not compromise patient safety in terms of clinical outcomes while reducing consumption.

nuanuaniao

建议发这种英文及时附上翻译，否则前沿资讯了解的人很少。

这个研究主要是说有一个“抗菌药物管理计划（ASPs）”，但是很多人质疑依照该计划进行降阶梯和停药是不是有负面作用，也质疑这个计划对患者的安全性。因此一个中心做了一个研究，2011年到2014年该机构回顾性分析了158次ASP干预措施。其中包括：碳青霉烯类药物停药（35％），更改为窄谱抗菌药物（32％），优化剂量（17％），进一步检查（包括成像，降钙素原）（11％），发生感染并转诊（3％），抗生素停药（碳青霉烯类除外）（1％）和来源控制（1％）。

然后做了一些统计，后来得到结论：

应用这个计划不会对患者的安全产生影响，并且节约了费用。

就完事了。

toto

nuanuaniao 发表于 2017-10-20 11:09
建议发这种英文及时附上翻译，否则前沿资讯了解的人很少。

这个研究主要是说有一个“抗菌药物管理计划（ ...

现在的翻译软件这么多………………

lyluoxiuhua

对这些前沿东东了解较少！