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首页> 外文期刊>The Canadian journal of hospital pharmacy. >Urinary Tract Infections: Leading Initiatives in Selecting Empiric Outpatient Treatment (UTILISE)
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Urinary Tract Infections: Leading Initiatives in Selecting Empiric Outpatient Treatment (UTILISE)

机译：尿路感染：选择经验性门诊治疗（UTILISE）的领先举措

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Background: Overuse of fluoroquinolone antibiotics is associated with outbreaks of methicillin-resistant Staphylococcus aureus and of Clostridium difficile-associated diarrhea and increasing resistance in gram-negative organisms. Over the past decade, resistance of Escherichia coli to ciprofloxacin has increased in the Regina Qu'Appelle Health Region. In August 2011, an exploratory audit of the Regina General Hospital (RGH) emergency department showed that 20% of new antibiotic orders were for fluoroquinolones, and 60% of these new fluoroquinolone orders were for ciprofloxacin. It was postulated that ciprofloxacin was predominantly prescribed for outpatients with urinary tract infection. Objective: To develop, implement, and evaluate a best-practice algorithm for the empiric treatment of uncomplicated urinary tract infection in the RGH emergency department, as part of an educational initiative for emergency physicians. Methods: A literature review was conducted and local antibiogram data were analyzed to establish a best-practice algorithm for treatment of uncomplicated urinary tract infection in outpatients seen in the emergency department. A chart review was conducted from January to March 2011 to establish a baseline of empiric antibiotic use. An educational strategy targeting emergency physicians described changes in antibiotic resistance patterns in the health region, principles of antimicrobial stewardship, drivers of resistance, and the results of a literature review of best practice for urinary tract infection in outpatients. A post-intervention audit was conducted from January to March 2012 to determine changes in practice. Results: Comparison of results from the post-intervention audit with baseline data showed that adherence to best practice increased significantly, from 41% (39/96) before the intervention to 66% (50/76) after the intervention (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.51-5.25; p < 0.001). There was also a significant change in overall antibiotic selection (OR 0.25, 95% CI 0.11-0.58;p< 0.001). Further analysis suggested that this significant change was driven by a decrease in use. of ciprofloxacin, from 32% (31/96) to 11% (8/76). Conclusion: Creation of a best-practice algorithm and education focused on emergency physicians significantly increased adherence to best practice and optimized antibiotic prescribing for outpatients with uncomplicated urinary tract infection by limiting overuse of fluoroquinolones, primarily ciprofloxacin.
机译：背景：过量使用氟喹诺酮类抗生素与耐甲氧西林的金黄色葡萄球菌和艰难梭菌相关的腹泻暴发以及革兰氏阴性菌的耐药性增加有关。在过去的十年中，里贾纳Qu'Appelle卫生区的大肠杆菌对环丙沙星的耐药性有所增加。 2011年8月，对里贾纳总医院（RGH）急诊科的探索性审核显示，新的抗生素订单中有20％用于氟喹诺酮类药物，而这些新的氟喹诺酮类抗生素中有60％用于环丙沙星。据推测，环丙沙星主要用于尿路感染的门诊患者。目的：开发，实施和评估RGH急诊科经验性治疗单纯性尿路感染的最佳实践算法，作为针对急诊医师的教育计划的一部分。方法：进行文献综述并分析局部抗菌素数据，以建立治疗急诊科门诊单纯性尿路感染的最佳实践算法。从2011年1月至2011年3月进行了图表审查，以建立经验性抗生素使用的基线。针对急诊医师的教育策略描述了健康区域抗生素耐药性模式的变化，抗菌素管理原则，耐药性驱动因素以及门诊患者尿路感染最佳实践的文献综述结果。 2012年1月至2012年3月进行了干预后审计，以确定实践中的变化。结果：干预后审核的结果与基准数据的比较表明，对最佳实践的依从性显着提高，从干预前的41％（39/96）增加到干预后的66％（50/76）（赔率[OR 2.81，95％置信区间[CI] 1.51-5.25; p ＜0.001）。总体抗生素选择也有显着变化（OR 0.25，95％CI 0.11-0.58; p <0.001）。进一步的分析表明，这一重大变化是由使用量减少所驱动的。环丙沙星的含量从32％（31/96）增至11％（8/76）。结论：通过限制氟喹诺酮类药物（主要是环丙沙星）的过度使用，针对急诊医师的最佳实践算法和教育的创建显着提高了对最佳实践的依从性，并为无复杂尿路感染的门诊患者优化了抗生素处方。

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