抗生素暴露强度对克洛斯特里迪奥伊德困难感染风险的影响
Michael J Ray1,2, Luke C Strnad2,3, Kendall J Tucker1
1Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA.
概括
抗生素频谱指数 (ASI) 提供了比治疗日 (DOT) 更精确的抗生素治疗强度测量. 较高的ASI与与医院相关的Clostridioides difficile感染 (HA-CDI) 的风险增加有关.
科学领域:
- 传染性疾病 传染性疾病
- 抗微生物药物管理委员会
- 医疗保健服务研究 医疗服务研究
背景情况:
- 抗生素是Clostridioides difficile感染 (CDI) 的主要危险因素.
- 测量抗菌药物管理对CDI的影响需要对抗生素治疗强度进行细分评估.
- 传统的指标,如治疗日 (DOT),可能无法完全捕捉与不同抗生素剂和治疗持续时间相关的CDI风险的变化.
研究的目的:
- 评估通过抗生素谱指数 (ASI) 测量的抗生素治疗强度与医院相关的CDI (HA-CDI) 之间的关联.
- 确定ASI是否提供与DOT相比更细致的风险衡量标准,以告知抗微生物管理干预措施.
主要方法:
- 从2018年1月到2020年3月,对35,457名住院患者进行了回顾性队列研究.
- 利用边际波桑回归模型来评估ASI和HA-CDI之间的独立关联.
- 计算HA-CDI的调整后相对风险,每单位增加每天抗生素的ASI.
主要成果:
- 68%的患者至少服用了一种抗生素.
- 观察到的发病率为每10,000个患者日中有4.1个HA-CDI病例.
- 抗生素每天每单位的ASI增加独立地与HA-CDI的1.09倍更高的风险相关 (相对风险=1.09;95% CI:1.06-1.13).
结论:
- 抗生素谱指数 (ASI) 与医院相关的CDI有很强的联系.
- ASI提供了比DOT更细致的抗生素暴露量.
- ASI可以成为评估抗生素管理计划在减少HA-CDI率方面的有效性的一种有价值的工具.
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