Adeel A Butt, Sherin Shams, Atika Jabeen, Asma Ali Al-Nuaimi, Jeyaram Illiayaraja Krishnan, Aimon B Malik, Samah Saleem, Maryam Hassan Abdulaziz, Naheel Ismail Seyam, Kamran Aziz, Dalia Kandil, Anil G Thomas, Hanaa Nafady-Hego, Muzna I Lone, Jameela Al Ajmi, Zain A Bhutta, Noora AlSulaiti, Wael E Said Hussein, Sandy Semaan, Samya Ahmad Al-Abdulla, Mohamed Ghaith Al-Kuwari, Abdul-Badi Abou-Samra
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引用次数: 0
摘要
背景：抗生素过度使用和日益增加的抗菌素耐药性是全球公共卫生威胁。我们确定了多组分干预对减少门诊上呼吸道感染（URTIs）不适当抗生素使用的影响。方法：设计：前瞻性、整群随机试验。干预：与随机分配的单一干预（决策支持算法）相比，捆绑的四组分干预包括广泛的提供者教育、决策支持算法、延迟抗生素处方的选择和处方模式的月度反馈。环境：卡塔尔的四个初级医疗保健中心，研究期间为2023年8月至2024年10月。参与者：被诊断为尿路感染并服用抗生素的个体。主要结果：在11个月的随访期间，干预组与对照组相比减少了不适当的抗生素处方。结果：我们分析了20,062例使用抗生素处方的尿路感染病例（对照组9,277例，干预组10,785例）。在考虑聚类效应的混合效应逻辑回归模型中，干预与不适当抗生素处方的几率降低29%相关([aOR] 0.71；95% ci 0.66-0.77)。相对降低20.9% (44.9% vs. 35.5%；结论：多组分干预可显著减少门诊尿路感染患者不适当的抗生素处方。临床试验：Gov id: NCT06135376，注册日期：2023年11月9日。
A prospective cluster randomized trial of an interventions bundle to reduce inappropriate antibiotic use for upper respiratory tract infections in the outpatient setting.
Background: Antibiotic overuse and increasing antimicrobial resistance are global public health threats. We determined the impact of a multicomponent intervention in reducing inappropriate antibiotic use for upper respiratory tract infections (URTIs) in the outpatient setting.
Intervention: Bundled 4-component intervention including extensive provider education, a decision support algorithm, option for deferred antibiotics prescription, and monthly feedback on prescription patterns, vs. a single randomly assigned intervention (decision support algorithm).
Setting: Four Primary healthcare centers in Qatar with study period from August 2023 to October 2024.
Participants: Individuals with a diagnosis of URTI who were prescribed antibiotics.
Main outcome(s): Reduction in inappropriate antibiotic prescriptions for URTIs in the intervention vs. control group during the 11-month follow-up period.
Results: We analyzed 20,062 episodes-of-care for URTIs with an antibiotic prescription (9,277 at control and 10,785 at intervention sites). In a mixed effects logistic regression model accounting for the clustering effect, the intervention was associated with a 29% reduction in odds of inappropriate antibiotics prescriptions ( [aOR] 0.71; 95% CI 0.66-0.77). The relative reduction was 20.9% (44.9% vs. 35.5%; p < 0.001) between the two groups. The relative drop in inappropriate antibiotic prescriptions before and after the interventions was 16.3% (42.4% vs 35.5%; p < 0.001) at intervention sites (p < 0.001) compared with 2.2% (45.9% to 44.9%; p = 0.4) at control sites. Senior-most physicians and younger population (19-40 years old) were more likely to prescribe or receive inappropriate antibiotic prescription.
Conclusion: A multi-component intervention can significantly reduce inappropriate antibiotic prescriptions for URTIs in the outpatient setting.
Clinicaltrials:
Gov id: NCT06135376, Registration Date: November 9, 2023.
期刊介绍：
BMC Infectious Diseases is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of infectious and sexually transmitted diseases in humans, as well as related molecular genetics, pathophysiology, and epidemiology.
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