药剂师-新冠肺炎住院患者的抗菌药物管理和抗生素使用。

Selena N Pham, Taylor M Hori, Ashfaq Shafiq
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引用次数: 0

摘要

背景:在新冠肺炎大流行期间,观察到经验性抗生素治疗的使用显著增加,尤其是在新冠肺炎住院患者中。改进抗生素处方是抗菌药物管理计划(ASP)的主要目标之一。ASP药剂师的执业范围允许改变抗感染疗法。方法:我们旨在描述内华达州南部退伍军人事务医疗保健系统新冠肺炎住院患者的抗生素处方,并确定该患者群体中细菌合并感染的流行率。我们对2020年11月1日至2021年1月31日入院的患者进行了回顾性图表审查。结果:研究期间,共有199名患者因实验室确诊的新冠肺炎感染入院,61名患者(31%)入院时接受了≥1种抗生素治疗,138名患者(69%)未接受抗生素治疗。47名患者(77%)在入院后72小时内被ASP团队停用抗生素。在199名入院患者中,有6人(3%)经微生物证实存在细菌共感染。铜绿假单胞菌是最常见的细菌(3种痰培养物),其次是氧化克雷伯菌(2种痰培养)。16名患者(8%)在住院期间发生医院感染。结论:高达31%的新冠肺炎感染住院患者因细菌合并感染而接受了经验性抗生素治疗。药剂师领导的ASP导致许多患者提前停用抗生素。在开始经验性抗生素治疗之前,彻底的临床检查以确定新冠肺炎患者细菌合并感染的风险是重要的。在新冠肺炎大流行期间继续推广ASP至关重要,以确保负责任地使用抗生素并防止抗微生物耐药性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pharmacist-Led Antimicrobial Stewardship and Antibiotic Use in Hospitalized Patients With COVID-19.

Background: During the COVID-19 pandemic, a significant increase in the use of empiric antibiotic therapy has been observed especially in patients hospitalized with COVID-19. Improving antibiotic prescribing is one of the main goals of the antimicrobial stewardship program (ASP). The ASP pharmacists have a scope of practice that authorizes changes in anti-infective therapy.

Methods: We aimed to describe antibiotic prescribing in patients hospitalized with COVID-19 at Veterans Affairs Southern Nevada Healthcare System with a pharmacist-led ASP and to determine the prevalence of bacterial coinfection in this patient population. We performed a retrospective chart review of patients admitted to the facility from November 1, 2020, to January 31, 2021.

Results: A total of 199 patients were admitted to the hospital for laboratory-confirmed COVID-19 infection during the study period and 61 patients (31%) received ≥ 1 antibiotic on hospital admission and 138 (69%) did not receive antibiotics. Forty-seven patients (77%) had antibiotics discontinued by the ASP team within 72 hours of admission. Of the 199 admitted, 6 (3%) had microbiologically confirmed bacterial coinfection. Pseudomonas aeruginosa was the most common organism (3 sputum cultures) followed by Klebsiella oxytoca (2 sputum cultures). Sixteen patients (8%) developed a nosocomial infection during their hospital stay.

Conclusions: Up to 31% of patients hospitalized for COVID-19 infection received empiric antibiotic treatment for concern of bacterial coinfection. Pharmacist-led ASP led to early discontinuation of antibiotics in many patients. A thorough clinical workup to determine the risk of bacterial coinfection in patients with COVID-19 is important before starting empiric antibiotic therapy. It is essential to continue promoting the ASP during the COVID-19 pandemic to ensure responsible antibiotic use and prevent antimicrobial resistance.

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