PDF(Pubmed)
Abstract：
Antimicrobials are the most frequently prescribed drug in pediatrics, with an estimated 37% of infants and 61% of hospitalized children having received them. Approximately 20-50% of prescriptions have been shown to be potentially unnecessary or inappropriate. The World Health Organization (WHO) estimates that the continued increase in antimicrobial resistance by the year 2050 will lead to the death of 10 million people per year. This paper describes a protocol to be used in a future study to evaluate the implementation of a quarterly syndromic antibiogram, aimed to improve the use of antibiotics for the treatment of pediatric bacterial infections at the Maputo Central Hospital, Mozambique. This study uses implementation science methods framed by the Dynamic Adaption Process (DAP) and RE-AIM conceptual frameworks to develop a multi-phase, mixed-methods evaluation utilizing qualitative and quantitative approaches. The pediatric inpatient services at HCM consist of approximately 18 physicians and 60 nurses. Additionally, the microbiology laboratory consists of eight laboratory technicians. We anticipate analyzing approximately 9,000 medical records. Qualitative methods include in-depth interviews with clinicians, laboratory technicians, and administrators to explore current knowledge and practices around antibiotic decision making, facilitators and barriers to intervention implementation, as well as acceptability and satisfaction with the intervention roll-out. Qualitative analysis will be performed with NVivo 12 software. Quantitative methods include extracting data from existing records from the pediatric ward of Hospital Central de Maputo (HCM) guided by the RE-AIM framework to explore intervention utilization and other factors influencing its implementation. Quantitative descriptive and inferential statistical analysis will be performed using R Studio statistical software. The findings from this evaluation will be shared with hospital administrators and relevant national policymakers and may be used by the Ministry of Health in deciding to expand this approach to other hospitals. The expected results of this research include the development of standard operating guidelines for the creation, distribution, and use of a quarterly syndromic antibiogram for antibiotic decision making that is informed by local epidemiology. Findings from this study will be used to develop a larger multi-site trial in Mozambique.
摘要：
抗菌药物是儿科最常用的处方药，估计有37％的婴儿和61％的住院儿童接受了这些治疗。大约20-50％的处方已被证明可能是不必要或不合适的。世界卫生组织（WHO）估计，到2050年，抗菌素耐药性的持续增加将导致每年1000万人死亡。本文介绍了一种方案，该方案将在未来的研究中使用，以评估季度综合征抗生素的实施情况。旨在改善马普托中心医院儿科细菌感染治疗抗生素的使用，莫桑比克。本研究使用由动态适应过程（DAP）和RE-AIM概念框架构成的实施科学方法来开发多阶段，采用定性和定量方法的混合方法评估。HCM的儿科住院服务由大约18名医生和60名护士组成。此外,微生物实验室由八名实验室技术人员组成。我们预计会分析大约9000份医疗记录。定性方法包括对临床医生的深入访谈，实验室技术人员,和管理人员探索抗生素决策的最新知识和实践，干预实施的促进者和障碍，以及对干预推广的可接受性和满意度。定性分析将使用NVivo12软件进行。定量方法包括在RE-AIM框架的指导下，从马普托中心医院儿科病房（HCM）的现有记录中提取数据，以探索干预措施的利用及其影响实施的其他因素。使用RStudio统计软件进行定量描述性和推断性统计分析。这项评估的结果将与医院管理人员和相关国家决策者分享，卫生部可能会在决定将这种方法扩展到其他医院时使用。这项研究的预期结果包括制定标准操作指南，分布，并根据当地流行病学信息，使用季度综合征性抗生素图进行抗生素决策。这项研究的结果将用于在莫桑比克开发更大的多地点试验。
