背景:在资源较少的环境中,来自抗菌药物管理计划的证据有限。这项研究旨在通过减少过度使用和促进在中等收入国家的重症监护病房(ICU)中使用窄谱药物来提高抗菌处方的质量。
方法:我们建立了一个质量改进协作(QIC)模型,该模型涉及9个阿根廷ICU,历时11个月,基线期(BP)为16周,实施期(IP)为32周。我们的干预方案包括对抗菌药物使用的审核和反馈,针对特定设施的治疗指南,抗菌超时,基于药学的干预和教育。干预是在两个学习课程中进行的,三个行动期以及教练支持和基本质量改进培训。
结果:我们纳入了912名患者,357在BP和555在IP。后者具有较高的APACHEII(17(95%CI:12至21)比15(95%CI:11至20),p=0.036),SOFA评分(6(95%CI:4至9)vs5(95%CI:3至8),p=0.006),肾功能衰竭(41.6%vs33.1%,p=0.009),脓毒症(36.1%vs31.6%,p<0.001)和感染性休克(40.0%vs33.8%,p<0.001)。两组之间的抗菌治疗(DOT)天数相似(从BP到IP28.1的斜率变化(95%CI:-17.4至73.5),p=0.2405)。两组之间的抗菌定义日剂量(DDD)没有差异(从BP到IP43.9的斜率变化(95%CI:-12.3至100.0),p=0.1413)。在IP期间,基于微生物培养的抗菌降级率较高(62.0%vs45.3%,p<0.001)。八个ICU增加了感染预防控制(IPC)评估框架。
结论:通过QIC在中等收入国家的ICU中实施抗菌药物管理计划证明,根据微生物培养结果,在改善抗菌药物降级方面取得了成功,但不是在DOT或DDD上。此外,九个ICU中有八个提高了IPC评估框架得分。
BACKGROUND: There is limited evidence from antimicrobial stewardship programmes in less-resourced settings. This study aimed to improve the quality of antibacterial prescriptions by mitigating overuse and promoting the use of narrow-spectrum agents in intensive care units (ICUs) in a middle-income country.
METHODS: We established a quality improvement collaborative (QIC) model involving nine Argentine ICUs over 11 months with a 16-week baseline period (BP) and a 32-week implementation period (IP). Our intervention package included audits and feedback on antibacterial use, facility-specific treatment guidelines, antibacterial timeouts, pharmacy-based interventions and education. The intervention was delivered in two learning sessions with three action periods along with coaching support and basic quality improvement training.
RESULTS: We included 912 patients, 357 in BP and 555 in IP. The latter had higher APACHE II (17 (95% CI: 12 to 21) vs 15 (95% CI: 11 to 20), p=0.036), SOFA scores (6 (95% CI: 4 to 9) vs 5 (95% CI: 3 to 8), p=0.006), renal failure (41.6% vs 33.1%, p=0.009), sepsis (36.1% vs 31.6%, p<0.001) and septic shock (40.0% vs 33.8%, p<0.001). The days of antibacterial therapy (DOT) were similar between the groups (change in the slope from BP to IP 28.1 (95% CI: -17.4 to 73.5), p=0.2405). There were no differences in the antibacterial defined daily dose (DDD) between the groups (change in the slope from BP to IP 43.9, (95% CI: -12.3 to 100.0), p=0.1413).The rate of antibacterial de-escalation based on microbiological culture was higher during the IP (62.0% vs 45.3%, p<0.001).The infection prevention control (IPC) assessment framework was increased in eight ICUs.
CONCLUSIONS: Implementing an antimicrobial stewardship program in ICUs in a middle-income country via a QIC demonstrated success in improving antibacterial de-escalation based on microbiological culture results, but not on DOT or DDD. In addition, eight out of nine ICUs improved their IPC Assessment Framework Score.