Facundo Jorro-Baron, Cecilia Inés Loudet, Wanda Cornistein, Inés Suarez-Anzorena, Pilar Arias-Lopez, Carina Balasini, Laura Cabana, Eleonora Cunto, Pablo Rodrigo Jorge Corral, Luz Gibbons, Marina Guglielmino, Gabriela Izzo, Marianela Lescano, Claudia Meregalli, Cristina Orlandi, Fernando Perre, Maria Elena Ratto, Mariano Rivet, Ana Paula Rodriguez, Viviana Monica Rodriguez, Jacqueline Vilca Becerra, Paula Romina Villegas, Emilse Vitar, Javier Roberti, Ezequiel García-Elorrio, Viviana Rodriguez
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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.</p><p><strong>Conclusion: </strong>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. 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引用次数: 0
摘要
背景：在资源较少的环境中开展抗菌药物管理项目的证据有限。本研究旨在通过减少过度使用抗菌药物，并在中等收入国家的重症监护病房（ICU）推广使用窄谱抗菌药物，从而提高抗菌药物处方的质量：我们建立了一个质量改进合作（QIC）模式，九个阿根廷重症监护病房参与其中，历时 11 个月，基线期（BP）16 周，实施期（IP）32 周。我们的一揽子干预措施包括对抗菌药物使用情况的审核和反馈、针对具体设施的治疗指南、抗菌药物超时使用、基于药房的干预和教育。干预措施分为两个学习阶段和三个行动阶段，同时还提供辅导支持和基本的质量改进培训：我们共纳入了 912 名患者，其中 357 人为 BP 患者，555 人为 IP 患者。后者的APACHE II（17（95% CI：12-21）vs 15（95% CI：11-20），p=0.036）、SOFA评分（6（95% CI：4-9）vs 5（95% CI：3-8），p=0.006）、肾衰竭（41.6% vs 33.1%，p=0.009）、败血症（36.1% vs 31.6%，p=0.009）均高于前者：在一个中等收入国家的重症监护病房通过QIC实施抗菌药物管理项目，成功改善了基于微生物培养结果的抗菌药物降级，但没有改善DOT或DDD。此外，9 个重症监护室中有 8 个提高了 IPC 评估框架得分。
Optimising antibacterial utilisation in Argentine intensive care units: a quality improvement collaborative.
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.
Conclusion: 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.
期刊介绍：
BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement.
The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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