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首页> 外文期刊>The Canadian journal of hospital pharmacy. >Growing a 'Positive Culture' of Antimicrobial Stewardship in a Community Hospital
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Growing a 'Positive Culture' of Antimicrobial Stewardship in a Community Hospital

机译：在社区医院培养抗菌素管理的“积极文化”

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Background: Promoting the appropriate use of antimicrobials is a core value of antimicrobial stewardship. Prospective audit and feedback constitute an effective strategy for reducing the cost and use of antimicrobials, as well as their adverse effects, such as infection with Clostridium Objective: To evaluate the antimicrobial stewardship program in the intensive care unit at the authors' hospital, in order to determine the cost and utilization of antimicrobials, as well as the rate of nosocomially acquired C. difficile infection. Methods: An infectious diseases team, consisting of a physician and a pharmacist, performed prospective audit and feedback during a pilot study (April to June 2010). The team met with the intensive care unit team daily to discuss optimization of therapy. The cost and utilization of antimicrobial drugs, as well as rates of C. difficile infection, were compared between the pilot period and the same period during the previous year (April to June 2009). For 3 months after the pilot phase (i.e., July to September 2010), the strategy was continued 3 days per week. Results: After introduction of the antimicrobial stewardship program, there was a significant reduction in the cost of antimicrobial drugs: dollar27 917 less than during the same period in the previous year, equivalent to a reduction of dollar15.45 (36.2%) per patient-day (dollar42.63 versus dollar27.18). Utilization of broad-spectrum antipseudomonal antimicrobial agents was also significantly lower, declining from 63.16 to 38.59 defined daily doses (DDDs) per 100 patient-days (reduction of 38.9%). After the pilot period, the rate declined further, to 28.47 DDDs/100 patient-days. During the pilot period, there were no cases of C, difficile infection, and in the post-pilot period, there was 1 case (overall rate 0.42 cases/1000 patient-days). This rate was lower than (but not significantly different from) the rate for April to September 2009 (1.87 cases/1000 patient-days). There wete no differences in mortality rate or severity of illness. Conclusion: The antimicrobial stewardship program in this community hospital was associated with significant decreases in antimicrobial costs and in utilization of antipseudomonal antimicrobial agents and a nonsignificant decrease in the rate of C. difficile infection. Knowledge exchange, peer-to-peer communication, and decision support, key factors in this success, will be applied in implementing the antimicrobial stewardship program throughout the hospital.
机译：背景：促进抗菌素的合理使用是抗菌素管理的核心价值。前瞻性的审核和反馈是降低抗菌药物的成本和使用及其不利影响（例如梭状芽胞杆菌感染）的有效策略。目的：评估作者医院重症监护病房的抗菌药物管理计划，以便确定抗菌药物的成本和利用率，以及医院获得的艰难梭菌感染率。方法：由医师和药剂师组成的传染病小组在一项初步研究（2010年4月至2010年6月）中进行了前瞻性审核和反馈。该团队每天与重症监护室团队进行会面，讨论治疗的优化方案。在试点期和上一年同期（2009年4月至2009年6月）之间比较了抗菌药物的成本和使用情况以及艰难梭菌感染率。在试行阶段后的3个月（即2010年7月至2010年9月）中，该策略每周持续3天。结果：实施抗菌管理计划后，抗菌药物的成本显着降低：比上年同期减少27 917美元，相当于每位患者减少15.45美元（36.2％），日（42.63美元兑27.18美元）。广谱抗假单胞菌抗菌剂的使用也显着降低，从每100个患者日的63.16定义每日剂量（DDD）下降到38.59（减少38.9％）。在试用期之后，该比率进一步下降，降至28.47 DDDs / 100患者-天。在试点期间，没有C，艰难梭菌感染的病例，在试点后阶段，有1例（总发病率0.42例/ 1000病人-天）。该比率低于（但无明显差异）2009年4月至2009年9月的比率（1.87例/ 1000病人日）。死亡率或疾病严重程度没有差异。结论：该社区医院的抗菌药物管理计划与抗菌药物成本的显着降低，抗假单胞菌抗菌药物的利用以及艰难梭菌感染率的无明显降低有关。知识交流，对等交流和决策支持是成功的关键因素，将被用于在整个医院实施抗菌素管理计划。

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