抗菌药物管理计划中多学科重症监护病房查房时抗生素暂停使用对患者生存的影响：一项前后对照研究。
Impact of Antibiotic Time-Outs in Multidisciplinary ICU Rounds for Antimicrobial Stewardship Program on Patient Survival: A Controlled Before-and-After Study.
作者信息
Mishima Yuka, Nawa Nobutoshi, Asada Mizuho, Nagashima Michio, Aiso Yoshibumi, Nukui Yoko, Fujiwara Takeo, Shigemitsu Hidenobu
机构信息
Department of Intensive Care Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Medical Education Research and Development, Tokyo Medical and Dental University, Tokyo, Japan.
出版信息
Crit Care Explor. 2023 Jan 6;5(1):e0837. doi: 10.1097/CCE.0000000000000837. eCollection 2023 Jan.
UNLABELLED
The antimicrobial stewardship program (ASP) is an important quality improvement initiative that is recommended in the ICU. However, the shortage of infectious disease physicians in Japan has led to the need for simpler methods for implementing ASPs. We investigated whether antibiotic time-outs (ATOs) during multidisciplinary rounds as part of an ASP can improve patient survival and reduce the number of days of therapy (DOT) with antibiotics.
DESIGN
Single-center controlled before-and-after study.
SETTING
Medical/surgical ICU in a tertiary university medical center in Tokyo, Japan.
PATIENTS
All patients 16 years old or older admitted consecutively in the ICU between October 2016 and March 2020.
INTERVENTIONS
An intensivist-driven ICU multidisciplinary round was introduced in October 2016, and ATOs with ICU rounds were implemented in June 2018. ATOs were conducted 3, 7, and 14 days after initiation of antibiotics.
MEASUREMENTS AND MAIN RESULTS
The primary outcome was the subdistribution hazard ratio (SHR) of survival to hospital discharge compared between multidisciplinary rounds (phase 1) and ATO during multidisciplinary rounds (phase 2) using the multivariable Fine-Gray model. The secondary outcomes were the SHR of survival to ICU discharge and the trends in the DOT with IV antibiotics per 1,000 patient-days between October 2016 and March 2020 by using interrupted time-series analysis. The number of patients in phases 1 and 2 was 777 and 796, respectively. The group that underwent ATO during multidisciplinary rounds showed a significant increase in the survival to hospital discharge in comparison with the multidisciplinary round-only group (SHR, 1.13; 95% CI, 1.02-1.25); however, the SHR of survival to ICU discharge showed no significant intergroup difference. The DOT with total IV antibiotics decreased after ATO implementation (change in intercept, -178.26; 95% CI, -317.74 to -38.78; change in slope, -7.00; 95% CI, -15.77 to 1.78).
CONCLUSIONS
ATOs during multidisciplinary rounds are associated with improved patient survival and reduced DOT.
未标注
抗菌药物管理计划（ASP）是重症监护病房（ICU）推荐实施的一项重要质量改进措施。然而，日本传染病医生短缺，因此需要更简便的方法来实施ASP。我们调查了作为ASP一部分的多学科查房期间的抗生素停用时间（ATO）是否能提高患者生存率并减少抗生素治疗天数（DOT）。
设计
单中心前后对照研究。
地点
日本东京一所三级大学医学中心的内科/外科ICU。
患者
2016年10月至2020年3月期间连续入住ICU的所有16岁及以上患者。
干预措施
2016年10月引入了由重症监护医生主导的ICU多学科查房，并于2018年6月在查房时实施ATO。在开始使用抗生素后的第3、7和14天进行ATO。
测量指标和主要结果
主要结局是使用多变量Fine-Gray模型比较多学科查房阶段（第1阶段）和多学科查房期间的ATO阶段（第2阶段）至出院存活的亚分布风险比（SHR）。次要结局是至ICU出院存活的SHR以及使用中断时间序列分析得出的2016年10月至2020年3月期间每1000患者日静脉使用抗生素的DOT趋势。第1阶段和第2阶段的患者人数分别为777例和796例。与仅进行多学科查房的组相比，多学科查房期间进行ATO的组至出院存活显著增加（SHR，1.13；95%CI，1.02 - 1.25）；然而，至ICU出院存活的SHR组间无显著差异。实施ATO后，静脉使用抗生素的DOT有所下降（截距变化，-178.26；95%CI，-317.74至-38.78；斜率变化，-7.00；95%CI，-15.77至1.78）。
结论
多学科查房期间的ATO与患者生存率提高和DOT减少相关。
Zotero 插件