背景：自1970年代以来，革兰氏染色已被用作我们医院抗菌药物管理的重要工具。这项研究的目的是阐明基于革兰氏染色选择的靶向疗法和基于日本使用的抗微生物指南的模拟经验疗法的差异。
方法：2013年5月至2014年4月在冲绳进行了一项基于转诊医院的前瞻性描述性研究。日本。所有入选的患者都是通过急诊室进入传染病科的成年人，在以下三个地点之一怀疑有细菌感染：呼吸系统，泌尿道,或皮肤和软组织。研究结果是最初选择的抗生素的类型和有效性，和他们的总成本。
结果：本研究纳入了28名患者。中位年龄为80岁。基于革兰氏染色选择的抗生素谱比基于日本指南选择的显著更窄。估计基于革兰氏染色和指南的治疗同样高效。革兰氏染色测试后的抗微生物剂总成本不到遵循指南后成本的一半。
结论：与日本指南相比，革兰氏染色显著减少了广谱抗微生物剂的过度使用而不影响治疗的有效性。当使用革兰氏染色时,药物成本降低了一半。革兰氏染色应包括在所有抗菌药物管理计划中。
BACKGROUND: The Gram stain has been used as an essential tool for antimicrobial stewardship in our hospital since the 1970s. The objective of this study was to clarify the difference in the targeted therapies selected based on the Gram stain and simulated empirical therapies based on the antimicrobial
guidelines used in Japan.
METHODS: A referral-hospital-based prospective descriptive study was undertaken between May 2013 and April 2014 in Okinawa, Japan. All enrolled patients were adults who had been admitted to the Division of Infectious Diseases through the emergency room with suspected bacterial infection at one of three sites: respiratory system, urinary tract, or skin and soft tissues. The study outcomes were the types and effectiveness of the antibiotics initially selected, and their total costs.
RESULTS: Two hundred eight patients were enrolled in the study. The median age was 80 years. A significantly narrower spectrum of antibiotics was selected based on the Gram stain than was selected based on the Japanese
guidelines. The treatments based on the Gram stain and on the
guidelines were estimated to be equally highly effective. The total cost of antimicrobials after Gram-stain testing was less than half the cost after the
guidelines were followed.
CONCLUSIONS: Compared with the Japanese
guidelines, the Gram stain dramatically reduced the overuse of broad-spectrum antimicrobials without affecting the effectiveness of the treatment. Drug costs were reduced by half when the Gram stain was used. The Gram stain should be included in all antimicrobial stewardship programs.
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