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首页> 外文期刊>BMC Pediatrics >Effect of a multi-faceted quality improvement intervention on inappropriate antibiotic use in children with non-bloody diarrhoea admitted to district hospitals in Kenya
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Effect of a multi-faceted quality improvement intervention on inappropriate antibiotic use in children with non-bloody diarrhoea admitted to district hospitals in Kenya

机译：肯尼亚地区医院收治的多方面质量改善干预措施对非血性腹泻患儿使用不当抗生素的影响

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Background There are few reports of interventions to reduce the common but irrational use of antibiotics for acute non-bloody diarrhoea amongst hospitalised children in low-income settings. We undertook a secondary analysis of data from an intervention comprising training of health workers, facilitation, supervision and face-to-face feedback, to assess whether it reduced inappropriate use of antibiotics in children with non-bloody diarrhoea and no co-morbidities requiring antibiotics, compared to a partial intervention comprising didactic training and written feedback only. This outcome was not a pre-specified end-point of the main trial. Methods Repeated cross-sectional survey data from a cluster-randomised controlled trial of an intervention to improve management of common childhood illnesses in Kenya were used to describe the prevalence of inappropriate antibiotic use in a 7-day period in children aged 2-59 months with acute non-bloody diarrhoea. Logistic regression models with random effects for hospital were then used to identify patient and clinician level factors associated with inappropriate antibiotic use and to assess the effect of the intervention. Results 9, 459 admission records of children were reviewed for this outcome. Of these, 4, 232 (44.7%) were diagnosed with diarrhoea, with 130 of these being bloody (dysentery) therefore requiring antibiotics. 1, 160 children had non-bloody diarrhoea and no co-morbidities requiring antibiotics-these were the focus of the analysis. 750 (64.7%) of them received antibiotics inappropriately, 313 of these being in the intervention hospitals vs. 437 in the controls. The adjusted logistic regression model showed the baseline-adjusted odds of inappropriate antibiotic prescription to children admitted to the intervention hospitals was 0.30 times that in the control hospitals (95%CI 0.09-1.02). Conclusion We found some evidence that the multi-faceted, sustained intervention described in this paper led to a reduction in the inappropriate use of antibiotics in treating children with non-bloody diarrhoea. Trial registration International Standard Randomised Controlled Trial Number Register ISRCTN42996612
机译：背景很少有干预措施的报道，以减少在低收入地区住院的儿童中常见但不合理使用抗生素治疗急性非血性腹泻的方法。我们对一项干预措施的数据进行了二次分析，包括干预措施，包括培训卫生工作者，协助，监督和面对面的反馈，以评估该措施是否减少了非血性腹泻且没有合并症的儿童使用抗生素的不当使用，而部分干预则仅包括教学训练和书面反馈。该结果并非主要试验的预定终点。方法采用一项整群随机对照试验的重复横断面调查数据，该试验通过一项干预措施来改善肯尼亚常见的儿童疾病的管理，用于描述2至59个月大的7岁以下儿童中7天不当使用抗生素的情况。急性非血性腹泻。然后使用对医院具有随机影响的逻辑回归模型来确定与抗生素使用不当相关的患者和临床医生水平因素，并评估干预措施的效果。结果对9 459例儿童的入院记录进行了评估。其中，有4 232名（44.7％）被诊断出腹泻，其中130名患有流血（痢疾），因此需要抗生素。 1,160名儿童患有非血性腹泻，并且没有需要使用抗生素的合并症，这些是分析的重点。其中750人（64.7％）不当使用抗生素，其中313人在干预医院，而对照组为437人。调整后的逻辑回归模型显示，入院干预儿童接受抗生素处方的基线调整几率是对照医院的0.30倍（95％CI 0.09-1.02）。结论我们发现一些证据表明，本文所述的多方面，持续的干预措施可以减少抗生素在治疗非血性腹泻儿童中的不当使用。试用注册国际标准随机对照试验编号寄存器ISRCTN42996612

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