■为了确定在曼谷Siriraj医院实施当地制定的用于社区获得性蜂窝织炎成人抗生素治疗的临床实践指南(CPG)的有效性,泰国。
■用于社区获得性蜂窝织炎的抗生素治疗的CPG是根据2016年6月至12月的当地数据开发的。CPG是通过多方面的干预措施引入的,包括海报,宣传册,通函,社交媒体,会议,课堂培训,以及2018年1月至9月期间的互动教育。
■在360名社区获得性蜂窝织炎患者中,84.4%为门诊,15.6%为住院。患者的中位年龄为62岁,59.4%为女性。251例患者(69.7%)观察到符合CPG的抗生素处方(CPG依从性组),在109例患者(30.3%)中发现了CPG不依从性(CPG不依从性组).两组患者的人口统计学和特征具有可比性。符合CPG治疗组的患者静脉注射抗生素的比例明显较低(18.7%vs33.9%,P=.007),广谱抗生素的处方率较低(14.7%vs78.9%,P<.001)和抗生素组合(6.4%vs13.8%,P=.022),抗生素治疗的中位持续时间较短(7天vs10天,P<.001),抗生素治疗的中位费用较低(3美元对7美元,P<.001),中位住院费用(601美元对1587美元,P=.008)低于CPG不合规组。两组之间的治疗结果没有显着差异。
坚持CPG似乎可降低社区获得性蜂窝织炎成人广谱抗生素或抗生素联合用药的不当处方和治疗成本,但在良好结局或不良事件方面无差异。
UNASSIGNED: To determine the effectiveness of implementing a locally developed clinical practice
guideline (CPG) for antibiotic treatment in adults with community-acquired
cellulitis at Siriraj Hospital in Bangkok, Thailand.
UNASSIGNED: The CPG for antibiotic treatment of community-acquired
cellulitis was developed based on local data during June to December 2016. The CPG was introduced by multifaceted interventions, including posters, brochures, circular letters, social media, conference, classroom training, and interactive education during January to September 2018.
UNASSIGNED: Among 360 patients with community-acquired
cellulitis, 84.4% were ambulatory and 15.6% were hospitalized. The median age of patients was 62 years, and 59.4% were female. Antibiotic prescription according to CPG (CPG-compliant group) was observed in 251 patients (69.7%), and CPG noncompliance was found in 109 patients (30.3%) (CPG-noncompliant group). The demographics and characteristics of patients were comparable between groups. Patients in the CPG-compliant group had a significantly lower rate of intravenous antibiotics (18.7% vs 33.9%, P = .007), lower prescription rate of broad-spectrum antibiotics (14.7% vs 78.9%, P < .001) and antibiotic combination (6.4% vs 13.8%, P = .022), shorter median duration of antibiotic treatment (7 vs 10 days, P < .001), lower median cost of antibiotic treatment (US $3 vs $7, P < .001), and lower median hospitalization cost (US $601 vs $1587, P = .008) than those in the CPG-noncompliant group. Treatment outcomes were not significantly different between groups.
UNASSIGNED: Adherence to CPG seems to reduce inappropriate prescription of broad-spectrum antibiotic or antibiotic combination and treatment costs in adults with community-acquired
cellulitis without differences in favorable outcomes or adverse events.