Abstract：
A quasi-experimental study was conducted on the implementation of locally developed clinical practice guidelines (CPGs) for empirical antibiotic (ATB) therapy of common infections (bacteremia, urinary tract infection (UTI), pneumonia) in the hospitals from January 2019 to December 2020. The CPGs were developed using data from patients with these infections at individual hospitals. Relevant CPG data pre- and post-implementation were collected and compared. Of the 1644 patients enrolled in the study, 808 and 836 were in the pre- and post-implementation periods, respectively, and patient outcomes were compared. Significant reductions in the mean durations of intensive care unit stay (3.44 ± 9.08 vs. 2.55 ± 7.89 days; p = 0.035), ventilator use (5.73 ± 12.14 vs. 4.22 ± 10.23 days; p = 0.007), piperacillin/tazobactam administration (0.954 ± 3.159 vs. 0.660 ± 2.217 days, p = 0.029), and cefoperazone/sulbactam administration (0.058 ± 0.737 vs. 0.331 ± 1.803 days, p = 0.0001) occurred. Multivariate analysis demonstrated that CPG-implementation was associated with favorable clinical outcomes (adjusted odds ratio 1.286, 95% confidence interval: 1.004-1.647, p = 0.046). Among patients who provided follow-up cultures (n = 284), favorable microbiological responses were significantly less frequent during the pre-implementation period than the post-implementation period (80.35% vs. 91.89%; p = 0.01). In conclusion, the locally developed CPG implementation is feasible and effective in improving patient outcomes and reducing ATB consumption. Hospital antimicrobial stewardship teams should be able to facilitate CPG development and implementation for antimicrobial therapy for common infections.
摘要：
进行了一项准实验研究，以实施当地制定的临床实践指南（CPG），用于经验性抗生素（ATB）治疗常见感染（菌血症，尿路感染（UTI），肺炎)从2019年1月到2020年12月在医院。CPG是使用来自各个医院的这些感染患者的数据开发的。收集并比较实施前后的相关CPG数据。在这项研究的1644名患者中，808和836处于实施前和实施后阶段，分别,和患者的预后进行了比较。重症监护病房平均住院时间显着减少（3.44±9.08vs.2.55±7.89天；p=0.035），呼吸机使用(5.73±12.14vs.4.22±10.23天；p=0.007），哌拉西林/他唑巴坦给药（0.954±3.159vs.0.660±2.217天，p=0.029),和头孢哌酮/舒巴坦给药（0.058±0.737vs.0.331±1.803天，p=0.0001）发生。多变量分析表明，CPG实施与良好的临床结局相关（调整比值比1.286，95％置信区间：1.004-1.647，p=0.046）。在提供随访培养的患者中（n=284），在实施前期间，有利的微生物反应明显低于实施后期间(80.35%vs.91.89%；p=0.01）。总之,当地制定的CPG实施在改善患者预后和减少ATB消耗方面是可行和有效的.医院抗菌药物管理团队应该能够促进针对常见感染的抗菌治疗的CPG开发和实施。
