葡萄牙医院高危发热性中性粒细胞减少症患者抗生素处方的差异

Marta Freitas, Paulo Andrade, Ricardo Pinto, Fernanda Trigo, Ana Azevedo, Francisco Almeida
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摘要

导言:发热性中性粒细胞减少症(FN)是一种潜在的严重并发症,尤其是在血液肿瘤患者中,他们感染耐多药细菌的几率更高。指南之间的差异导致了抗菌治疗方法的不同。我们的目的是评估葡萄牙血液科医生对高风险 FN 的抗菌治疗方法的差异。方法:我们通过在线调查进行了一项横断面研究,该调查面向全国所有临床血液学专家。为了描述有关 FN 管理关键要素的实践模式,我们设计了三个临床小故事,分别描述可使用窄谱经验性抗生素(小故事 1)、短程疗法(小故事 2)和降级疗法(小故事 3)的典型情况。其余问题涉及临床经验、科室规模、FN 抗生素治疗的区分和决策过程。结果:调查共收到来自四个地区 11 家医院的 31 份回复。所有受访者都选择了经验性窄谱抗生素,22.6%的受访者选择了短程治疗(主要是来自大型医院的资深专家),35.5%的受访者选择了降级治疗(主要是年轻专家)。有无 FN 方案似乎对这两种方法都有利。这些研究结果应辅以对最佳实践障碍的定性评估,并应支持采取干预措施改善发热性中性粒细胞减少症抗生素使用的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Variation in Antibiotic Prescription in High-Risk Febrile Neutropenia in Portuguese Hospitals
Introduction: Febrile neutropenia (FN) is a potentially severe entity, particularly in hemato-oncologic patients who have higher incidence of colonization with multidrug-resistant bacteria. Discrepancies among guidelines contribute to divergence in antimicrobial practices. Our objective was to assess the variation of practices in antimicrobial therapy in high-risk FN among Portuguese hematologists. Methods: We conducted a cross-sectional study through the implementation of an online survey, open to all clinical hematologists in the country. To characterize practice patterns regarding critical elements in FN management, three clinical vignettes were designed to describe typical situations where narrow-spectrum empiric antibiotics (vignette 1), short-course therapy (vignette 2) and de-escalation (vignette 3) could be performed. The remaining questions characterized clinical experience, department size, and differentiation and decision-making process regarding FN antibiotic therapy. Results: The survey yielded 31 responses from 11 hospitals across four regions. All respondents opted for empiric narrow-spectrum antibiotics, 22.6% opted for short-course therapy (mostly senior specialists from larger settings) and 35.5% for de-escalation (mostly young specialists). Availability of an FN protocol seemed to favor both approaches. These findings should be complemented by qualitative assessments of barriers to best practices and should support the need for interventions to improve antibiotic use in febrile neutropenia.
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