目的:我们的目的是评估碳青霉烯处方与医院和社区获得性感染指南的依从性。
方法:我们在大学医院进行了为期四个月的前瞻性研究。我们纳入了所有接受至少一剂碳青霉烯的成人和儿科住院患者。数据来自患者的医疗记录(硬拷贝和计算机化数据;CristalLink软件)。两名传染病专家评估了对指南的遵守情况。评估标准包括适应症,抗生素的选择,剂量,和治疗持续时间。
结果:我们纳入了152名患者(65.4%的男性)。碳青霉烯类处方适用于76.3%的处方。碳青霉烯类抗生素的使用被认为适用于73.9%的经验处方和77.8%的记录处方。不遵守指南主要是由于社区获得性感染的处方。40.3%的患者无法开始抗生素降级,只有51.7%的患者可以考虑抗生素降级。虽然平均治疗时间为7.5天,23.7%的患者接受碳青霉烯类抗生素治疗超过10天。
结论:这些结果强调了我们医院需要一个强有力的碳青霉烯管理项目。
OBJECTIVE: We aimed to evaluate carbapenem prescription compliance with
guidelines for nosocomial and community-acquired infections.
METHODS: We conducted a prospective study over a four-month period at our university hospital. We included all adult and pediatric hospitalized patients who had received at least one dose of carbapenem. Data was collected from patients\' medical records (hard copy and computerized data; CristalLink software). Compliance with
guidelines was assessed by two infectious disease specialists. Assessment criteria included indication, antibiotic choice, dosage, and treatment duration.
RESULTS: We included 152 patients in the study (65.4% of men). Carbapenem prescription was appropriate for 76.3% of prescriptions. The use of carbapenems was considered appropriate for 73.9% of empirical prescriptions and for 77.8% of documented prescriptions. Non-compliance with
guidelines was mainly due to prescriptions for community-acquired infections. Antibiotic de-escalation could not be initiated in 40.3% of patients and was only initiated in 51.7% of patients for whom it could be considered. Although the average treatment duration was 7.5 days, 23.7% of patients received carbapenems for more than 10 days.
CONCLUSIONS: These results highlight the need for a strong carbapenem stewardship program in our hospital.