医生的抗菌素处方和一般医疗病房患者的结果:一个多中心的回顾性队列研究
Mark T McIntyre1, Sudipta Saha2, Andrew M Morris2
1Sinai Health (McIntyre, Fralick), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (McIntyre), University of Toronto; Li Ka Shing Knowledge Institute (Saha, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Department of Social and Behavioral Sciences (Saha), Harvard T.H. Chan School of Public Health, Boston, Mass.; Department of Medicine (Morris, Lapointe-Shaw, Weinerman, Fralick, Verma, Razak), University of Toronto; Department of Medicine (Morris), Mount Sinai Hospital and University Health Network; Department of Medicine (Lapointe-Shaw), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Agarwal); Department of Medicine (Agarwal), McMaster University, Hamilton, Ont. mark.mcintyre@sinaihealth.ca.
医生处方的抗微生物剂的数量和频谱有显著的变化,但与患者的特征或结果没有相关性. 针对最低处方四分位数可能会加强抗微生物药物管理工作.
科学领域:
- 内部医学 内部医学
- 传染性疾病 传染性疾病
- 医疗保健服务研究 医疗服务研究
背景情况:
- 抗微生物药物处方变异性表明可能改善抗微生物药物的使用.
- 成年普通医疗病房的医生级别的处方做法需要调查.
- 了解影响抗微生物药物处方的因素对于管理至关重要.
研究的目的:
- 测量医生级抗微生物药物处方量和频谱.
- 评估与处方变化相关的患者级因素.
- 评估抗微生物药物处方和临床结果之间的联系.
主要方法:
- 使用通用医学住院患者倡议 (GEMINI) 数据库 (2010年4月至2019年12月) 的回顾性队列研究.
- 医生根据抗微生物药物处方量和光谱 (修改光谱得分) 分为四分位数.
- 用于评估处方和结果 (死亡率,停留时间,ICU转移,再接收) 之间的关联的多层次建模.
主要成果:
- 分析了124名医生和124,158名入院者;在开处方四分位数时,患者基线特征没有差异.
- 观察到处方量 (30%高于Q4比Q1) 和频谱的显著变化.
- 在医院死亡,住院时间,重症监护室转移或医生季度再入院方面没有显著差异.
- 较高的住院死亡率与更高的修改频谱得分相关 (OR 1.13,95% CI 1.04-1.24).
结论:
- 抗微生物药物处方的医生级别变化与学术通用医学病房的患者特征或临床结果没有相关性.
- 调查结果支持针对医生抗微生物药物处方的最低四分位数的抗微生物药物管理计划.
- 进一步的研究可能会探索特定的干预措施,以优化抗微生物药物的使用,而不影响患者的护理.
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