PDF(Pubmed)
Abstract：
In primary care, urinary tract infections (UTIs) account for the majority of antibiotic prescriptions. Comments from microbiologists on interpreting the antimicrobial susceptibility testing (AST) profile for urinalysis were made to improve the prescription of antibiotics. We aimed to explore the added value of these comments on the quality of antibiotic prescribing by a superior double-blind digital randomized case-vignette trial among French general practitioners (GPs). One case vignette with (intervention) or without (control) a \'comment\' after AST was randomly assigned to GPs. Among 815 participating GPs, 64.7% were women, at an average age of 37 years. Most (90.1%) used a computerized decision support system for prescribing antibiotics. Empirical antibiotic therapy was appropriate in 71.9% (95% CI, 68.8-75.0) of the cases, without differences between arms. The overall appropriateness of targeted antibiotic therapy (primary outcome) was not significantly increased when providing \'comments\': 83.4% vs. 79.9% (OR = 1.26, 95% CI, 0.86-1.85). With the multivariate analysis, the appropriateness was improved by 2-folds (OR = 2.38, 95% CI, 1.02-6.16) among physicians working in healthcare facilities. Among digital-affine young general practitioners, the adjunction of a \'comment\' by a microbiologist to interpret urinalysis in community-acquired UTIs did not improve the overall level of appropriateness of the targeted antibiotic.
摘要：
在初级保健中，尿路感染（UTI）占抗生素处方的大多数。微生物学家对解释尿液分析的抗菌药物敏感性测试（AST）概况发表了评论，以改善抗生素的处方。我们旨在通过法国全科医生（GP）中的高级双盲数字随机病例小插图试验，探索这些评论对抗生素处方质量的附加值。将AST后有（干预）或没有（对照）的一个病例小插图随机分配给全科医生。在815名参与的全科医生中，64.7%是女性，平均年龄37岁。大多数（90.1％）使用计算机化的决策支持系统来处方抗生素。经验性抗生素治疗在71.9%（95%CI，68.8-75.0）的病例中是合适的，没有武器之间的差异。提供“评论”时，靶向抗生素治疗（主要结果）的总体适当性没有显着增加：83.4％vs.79.9%（OR=1.26，95%CI，0.86-1.85）。通过多变量分析，在医疗机构工作的医生的适当性提高了2倍(OR=2.38,95%CI,1.02-6.16).在数字仿射年轻全科医生中，微生物学家在社区获得性尿路感染中对尿液分析进行解释的评论并未提高靶向抗生素的整体适当性水平.
