PDF(Pubmed)
Abstract：
UNASSIGNED: Antimicrobial stewardship programs can optimize antimicrobial use and have been federally mandated in all hospitals. However, best stewardship practices in immunocompromised patients with cancer are not well established.
UNASSIGNED: An antimicrobial time out, in the form of an email, was sent to physicians caring for hospitalized patients reaching 5 days of therapy for targeted antimicrobials (daptomycin, linezolid, tigecycline, vancomycin, imipenem/cilastatin, meropenem) in a comprehensive cancer center. Physicians were to discontinue the antimicrobial if unnecessary or document a rationale for continuation. This is a quasi-experimental, interrupted time series analysis assessing antimicrobial use during the following times: period 1 (before time-out: January 2007-June 2010) and period 2 (after time-out: July 2010-March/2015). The primary antimicrobial consumption metric was mean duration of therapy. Days of therapy per 1000 patient-days were also assessed.
UNASSIGNED: Implementation of the time-out was associated with a significant decrease in mean duration of therapy for the following antimicrobials; daptomycin: -0.89 days (95% confidence interval [CI], -1.38 to -.41); linezolid: -0.89 days (95% CI, -1.27 to -.52); meropenem: -0.97 days (95% CI, -1.39 to -.56); tigecycline: -1.41 days (95% CI, -2.19 to -.63); P < .001 for each comparison. Days of therapy/1000 patient-days decreased significantly for meropenem (-43.49; 95% CI, -58.61 to -28.37; P < .001), tigecycline (-35.47; 95% CI, -44.94 to -26.00; P < .001), and daptomycin (-9.47; 95% CI, -15.25 to -3.68; P = .002).
UNASSIGNED: A passive day 5 time-out was associated with reduction in targeted antibiotic use in a cancer center and could potentially be successfully adopted to several settings and electronic health records.
UNASSIGNED: An antimicrobial time out, in the form of an email, was sent to physicians caring for hospitalized patients reaching 5 days of therapy for targeted antimicrobials (daptomycin, linezolid, tigecycline, vancomycin, imipenem/cilastatin, meropenem) in a comprehensive cancer center. Physicians were to discontinue the antimicrobial if unnecessary or document a rationale for continuation. This is a quasi-experimental, interrupted time series analysis assessing antimicrobial use during the following times: period 1 (before time-out: January 2007-June 2010) and period 2 (after time-out: July 2010-March/2015). The primary antimicrobial consumption metric was mean duration of therapy. Days of therapy per 1000 patient-days were also assessed.
UNASSIGNED: Implementation of the time-out was associated with a significant decrease in mean duration of therapy for the following antimicrobials; daptomycin: -0.89 days (95% confidence interval [CI], -1.38 to -.41); linezolid: -0.89 days (95% CI, -1.27 to -.52); meropenem: -0.97 days (95% CI, -1.39 to -.56); tigecycline: -1.41 days (95% CI, -2.19 to -.63); P < .001 for each comparison. Days of therapy/1000 patient-days decreased significantly for meropenem (-43.49; 95% CI, -58.61 to -28.37; P < .001), tigecycline (-35.47; 95% CI, -44.94 to -26.00; P < .001), and daptomycin (-9.47; 95% CI, -15.25 to -3.68; P = .002).
UNASSIGNED: A passive day 5 time-out was associated with reduction in targeted antibiotic use in a cancer center and could potentially be successfully adopted to several settings and electronic health records.
摘要：
■抗菌药物管理计划可以优化抗菌药物的使用，并已在所有医院得到联邦政府的授权。然而,免疫功能低下的癌症患者的最佳管理实践尚未建立。
■抗菌药物超时，以电子邮件的形式，被送往照顾住院患者的医生，这些患者达到5天的靶向抗菌药物治疗(达托霉素，利奈唑胺,替加环素,万古霉素,亚胺培南/西司他丁，美罗培南）在一个综合的癌症中心。如果不必要，医师应停止抗菌药物或记录继续使用的理由。这是准实验,中断的时间序列分析评估以下时间的抗菌药物使用:第1期(暂停前:2007年1月-2010年6月)和第2期(暂停后:2010年7月-2015年3月).主要的抗菌药物消耗量指标是平均治疗持续时间。还评估了每1000名患者的治疗天数-天。
■实施超时与以下抗菌药物的平均治疗持续时间显着减少有关；达托霉素：-0.89天（95％置信区间[CI]，-1.38至-.41）；利奈唑胺：-0.89天（95％CI，-1.27至-.52）；美罗培南：-0.97天（95％CI，-1.39至-.56）；替加环素：-1.41天（95％CI，-2.19至-.63）；每次比较P<.001。美罗培南的治疗天数/1000患者-天数显着降低（-43.49;95％CI，-58.61至-28.37;P<.001），替加环素（-35.47；95%CI，-44.94至-26.00；P<.001），和达托霉素（-9.47；95%CI，-15.25至-3.68；P=0.002）。
第5天的被动超时与癌症中心的靶向抗生素使用减少有关，并有可能成功地应用于多个设置和电子健康记录。
■抗菌药物超时，以电子邮件的形式，被送往照顾住院患者的医生，这些患者达到5天的靶向抗菌药物治疗(达托霉素，利奈唑胺,替加环素,万古霉素,亚胺培南/西司他丁，美罗培南）在一个综合的癌症中心。如果不必要，医师应停止抗菌药物或记录继续使用的理由。这是准实验,中断的时间序列分析评估以下时间的抗菌药物使用:第1期(暂停前:2007年1月-2010年6月)和第2期(暂停后:2010年7月-2015年3月).主要的抗菌药物消耗量指标是平均治疗持续时间。还评估了每1000名患者的治疗天数-天。
■实施超时与以下抗菌药物的平均治疗持续时间显着减少有关；达托霉素：-0.89天（95％置信区间[CI]，-1.38至-.41）；利奈唑胺：-0.89天（95％CI，-1.27至-.52）；美罗培南：-0.97天（95％CI，-1.39至-.56）；替加环素：-1.41天（95％CI，-2.19至-.63）；每次比较P<.001。美罗培南的治疗天数/1000患者-天数显着降低（-43.49;95％CI，-58.61至-28.37;P<.001），替加环素（-35.47；95%CI，-44.94至-26.00；P<.001），和达托霉素（-9.47；95%CI，-15.25至-3.68；P=0.002）。
第5天的被动超时与癌症中心的靶向抗生素使用减少有关，并有可能成功地应用于多个设置和电子健康记录。
