前瞻性审核和反馈抗菌药物管理计划对碳青霉烯类药物使用的影响：一项准实验研究（IPANEMA 研究）。

Impact of a prospective audit and feedback antimicrobial stewardship programme on carbapenem consumption: a quasi-experimental study (IPANEMA study).

机构信息

Infectious Disease Department, Hospital Universitari de Bellvitge-Idibell, Hospitalet de Llobregat, Barcelona, Spain.

Pharmacy Department, Hospital Universitari de Bellvitge-Idibell, Hospitalet de Llobregat, Barcelona, Spain.

出版信息

J Antimicrob Chemother. 2023 Jul 5;78(7):1705-1710. doi: 10.1093/jac/dkad160.

DOI:10.1093/jac/dkad160

PMID:37248767

Abstract

OBJECTIVES

To test the hypothesis that a prospective audit and feedback (PAF) intervention combined with electronic tools will reduce carbapenem use without negatively affecting patient outcomes.

METHODS

A quasi-experimental, pre-intervention and intervention study was performed conducted in the urology department of a university hospital. The intervention involved implementing a PAF within an antimicrobial stewardship programme with the aid of an electronic tool. The primary outcome was carbapenem use, assessed by DDD/100 patient-days (PD). Secondary outcomes included evaluating the effect of the intervention on overall antibiotic use measured by DDD/100 PD and days of therapy (DOT)/100 PD, as well as patient safety. The chi-squared test or t-test was used, and the Poisson model was employed to assess the association between the intervention and outcomes.

RESULTS

A 9% decrease in carbapenem DDD/100 PD was observed during the intervention period (IR = 0.91; 95% CI = 0.85-0.97, P = 0.007). The proportion of patients who received carbapenem treatment dropped from 17.8% to 16.5% [incidence ratio (IR) = 0.95; 95% CI = 0.86-2.05, P = 0.31]. Carbapenem DOT/100 PD decreased from 12.4 to 11.0 (IR = 0.89; 95% CI = 0.83-0.94, P < 0.001). Overall antibiotic DDD/100 PD decreased by 3% (IR = 0.97; 95% CI = 0.94-0.99, P = 0.001) and DOT/100 PD by 7% (IR = 0.93; 95% CI = 0.91-0.95, P < 0.001). The incidence of infections caused by carbapenemase-producing microorganisms, Enterococcus faecium bacteraemia and Clostridioides difficile-associated diarrhoea episodes was similar in the pre-intervention and intervention periods. ESBL incidence rate decreased, but the differences were not statistically significant (3.94/1000 PD versus 2.88/1000 PD, P = 0.111). Length of hospital stay, in-hospital all-cause mortality, and 30 day readmission incidence remained unchanged.

CONCLUSIONS

The implementation of PAF combined with an electronic tool was an effective and safe intervention for reducing carbapenem use.

摘要

目的

检验前瞻性审核和反馈（PAF）干预措施结合电子工具的假设，即该措施可减少碳青霉烯类药物的使用，同时不会对患者的预后产生负面影响。

方法

在一家大学医院的泌尿科进行了一项准实验性、干预前和干预后研究。该干预措施包括在抗菌药物管理计划中实施 PAF，并借助电子工具提供支持。主要结局指标为每 100 名患者-天（PD）的碳青霉烯类药物使用量（DDD）。次要结局指标包括评估干预措施对整体抗生素使用量（DDD/100 PD 和治疗天数（DOT）/100 PD）和患者安全性的影响。采用卡方检验或 t 检验，采用泊松模型评估干预与结局之间的关系。

结果

干预期间碳青霉烯类药物 DDD/100 PD 降低了 9%（调整后发病率比[IR]为 0.91；95%置信区间[CI]为 0.85-0.97，P=0.007）。接受碳青霉烯类药物治疗的患者比例从 17.8%降至 16.5%（发病率比[IR]为 0.95；95%CI为 0.86-2.05，P=0.31）。碳青霉烯类药物 DOT/100 PD 从 12.4 降至 11.0（IR 为 0.89；95%CI 为 0.83-0.94，P<0.001）。总体抗生素 DDD/100 PD 降低了 3%（IR 为 0.97；95%CI 为 0.94-0.99，P=0.001），DOT/100 PD 降低了 7%（IR 为 0.93；95%CI 为 0.91-0.95，P<0.001）。碳青霉烯类药物耐药微生物、屎肠球菌菌血症和艰难梭菌相关性腹泻发作引起的感染发生率在干预前和干预期间相似。产超广谱β-内酰胺酶（ESBL）的发生率降低，但差异无统计学意义（3.94/1000 PD 与 2.88/1000 PD，P=0.111）。住院时间、院内全因死亡率和 30 天再入院率保持不变。