PDF(Pubmed)
Abstract：
BACKGROUND: Widespread inappropriate use of antimicrobial substances drives resistance development worldwide. In long-term care facilities (LTCF), antibiotics are among the most frequently prescribed medications. More than one third of antimicrobial agents prescribed in LTCFs are for urinary tract infections (UTI). We aimed to increase the number of appropriate antimicrobial treatments for UTIs in LTCFs using a multi-faceted antimicrobial stewardship intervention.
METHODS: We performed a non-randomized cluster-controlled intervention study. Four LTCFs of the Geriatric Health Centers Graz were the intervention group, four LTCFs served as control group. The main components of the intervention were: voluntary continuing medical education for primary care physicians, distribution of a written guideline, implementation of the project homepage to distribute guidelines and videos and onsite training for nursing staff. Local nursing staff recorded data on UTI episodes in an online case report platform. Two blinded reviewers assessed whether treatments were adequate.
RESULTS: 326 UTI episodes were recorded, 161 in the intervention group and 165 in the control group. During the intervention period, risk ratio for inadequate indication for treatment was 0.41 (95% CI 0.19-0.90), p = 0.025. In theintervention group, the proportion of adequate antibiotic choices increased from 42.1% in the pre-intervention period, to 45.9% during the intervention and to 51% in the post-intervention period (absolute increase of 8.9%). In the control group, the proportion was 36.4%, 33.3% and 33.3%, respectively. The numerical difference between intervention group and control group in the post-intervention period was 17.7% (difference did not reach statistical significance). There were no significant differences between the control group and intervention group in the safety outcomes (proportion of clinical failure, number of hospital admissions due to UTI and adverse events due to antimicrobial treatment).
CONCLUSIONS: An antimicrobial stewardship program consisting of practice guidelines, local and web-based education for nursing staff and general practitioners resulted in a significant increase in adequate treatments (in terms of decision to treat the UTI) during the intervention period. However, this difference was not maintained in the post-intervention phase. Continued efforts to improve the quality of prescriptions further are necessary.
BACKGROUND: The trial was registered at ClinicalTrials.gov NCT04798365.
METHODS: We performed a non-randomized cluster-controlled intervention study. Four LTCFs of the Geriatric Health Centers Graz were the intervention group, four LTCFs served as control group. The main components of the intervention were: voluntary continuing medical education for primary care physicians, distribution of a written guideline, implementation of the project homepage to distribute guidelines and videos and onsite training for nursing staff. Local nursing staff recorded data on UTI episodes in an online case report platform. Two blinded reviewers assessed whether treatments were adequate.
RESULTS: 326 UTI episodes were recorded, 161 in the intervention group and 165 in the control group. During the intervention period, risk ratio for inadequate indication for treatment was 0.41 (95% CI 0.19-0.90), p = 0.025. In theintervention group, the proportion of adequate antibiotic choices increased from 42.1% in the pre-intervention period, to 45.9% during the intervention and to 51% in the post-intervention period (absolute increase of 8.9%). In the control group, the proportion was 36.4%, 33.3% and 33.3%, respectively. The numerical difference between intervention group and control group in the post-intervention period was 17.7% (difference did not reach statistical significance). There were no significant differences between the control group and intervention group in the safety outcomes (proportion of clinical failure, number of hospital admissions due to UTI and adverse events due to antimicrobial treatment).
CONCLUSIONS: An antimicrobial stewardship program consisting of practice guidelines, local and web-based education for nursing staff and general practitioners resulted in a significant increase in adequate treatments (in terms of decision to treat the UTI) during the intervention period. However, this difference was not maintained in the post-intervention phase. Continued efforts to improve the quality of prescriptions further are necessary.
BACKGROUND: The trial was registered at ClinicalTrials.gov NCT04798365.
摘要：
背景：抗菌物质的广泛不当使用推动了全球耐药性的发展。在长期护理机构(LTCF)中，抗生素是最常用的处方药之一。LTCF中规定的超过三分之一的抗微生物剂用于尿路感染(UTI)。我们旨在使用多方面的抗菌管理干预措施，增加LTCF中UTI的适当抗菌治疗数量。
方法：我们进行了一项非随机整群对照干预研究。格拉茨老年保健中心的四个LTCF是干预组，四个LTCF作为对照组。干预的主要组成部分是：初级保健医生自愿继续医学教育，分发书面指南，实施项目主页，为护理人员分发指南和视频以及现场培训。当地护理人员在在线病例报告平台上记录了UTI发作的数据。两名盲审稿人评估了治疗是否足够。
结果：记录了326次UTI发作，干预组161例，对照组165例。干预期间,治疗指征不足的风险比为0.41(95%CI0.19-0.90)，p=0.025。在干预组中，充足的抗生素选择比例从干预前的42.1%增加，干预期间为45.9%，干预后为51%（绝对增长8.9%）。在对照组中，比例为36.4%，33.3%和33.3%，分别。干预后干预组与对照组的数值差异为17.7%(差异无统计学意义)。对照组和干预组在安全性结果(临床失败比例,由于UTI导致的住院人数和由于抗菌治疗导致的不良事件）。
结论：由实践指南组成的抗菌药物管理计划，针对护理人员和全科医生的本地和基于网络的教育导致干预期间适当治疗(就治疗UTI的决定而言)显著增加.然而,这一差异在干预后阶段没有维持.有必要继续努力提高处方质量。
背景：该试验在ClinicalTrials.govNCT04798365注册。
方法：我们进行了一项非随机整群对照干预研究。格拉茨老年保健中心的四个LTCF是干预组，四个LTCF作为对照组。干预的主要组成部分是：初级保健医生自愿继续医学教育，分发书面指南，实施项目主页，为护理人员分发指南和视频以及现场培训。当地护理人员在在线病例报告平台上记录了UTI发作的数据。两名盲审稿人评估了治疗是否足够。
结果：记录了326次UTI发作，干预组161例，对照组165例。干预期间,治疗指征不足的风险比为0.41(95%CI0.19-0.90)，p=0.025。在干预组中，充足的抗生素选择比例从干预前的42.1%增加，干预期间为45.9%，干预后为51%（绝对增长8.9%）。在对照组中，比例为36.4%，33.3%和33.3%，分别。干预后干预组与对照组的数值差异为17.7%(差异无统计学意义)。对照组和干预组在安全性结果(临床失败比例,由于UTI导致的住院人数和由于抗菌治疗导致的不良事件）。
结论：由实践指南组成的抗菌药物管理计划，针对护理人员和全科医生的本地和基于网络的教育导致干预期间适当治疗(就治疗UTI的决定而言)显著增加.然而,这一差异在干预后阶段没有维持.有必要继续努力提高处方质量。
背景：该试验在ClinicalTrials.govNCT04798365注册。
