BLADDER评分:评估一种工具,以支持住院成年人的尿路诊断和抗生素管理
Bradley J Langford1,2, Stephanie Amoah1,3, Jennifer Hansen1
1Hotel Dieu Shaver Health and Rehabilitation Centre, St. Catharines, ON, Canada.
Infection control and hospital epidemiology
|August 28, 2024
概括
一个新的评分工具,BLADDER评分,有效地减少了不必要的尿液培养和抗生素处方在老年人怀疑尿路感染 (UTI). 这种干预措施改善了抗微生物药物管理,但没有对患者的治疗结果产生负面影响.
科学领域:
- 老年医学 老年医学
- 传染性疾病 传染性疾病
- 抗微生物药物管理委员会
背景情况:
- 在老年人中,过度使用抗生素治疗无症状细菌性尿症是一个重大问题,有助于抗菌素耐药性.
- 当前的做法往往导致不必要的尿液培养和抗生素处方,因为怀疑尿路感染 (UTI).
- 需要有效的策略来优化这种脆弱人群中的抗生素使用.
研究的目的:
- 评估一种新的评分工具BLADDER评分对尿液培养和抗生素处方实践的影响.
- 评估干预对患者结局的影响,包括停留时间,急性护理转移和死亡率.
- 确定该工具在改善疑似尿道感染的诊断准确性和抗菌药物管理方面的实用性.
主要方法:
- 在一家134张床位的持续护理医院进行了一项准实验性中断时间序列研究.
- 该干预涉及一种多方面的方法,以6项BLADDER评分为中心,加上对医疗保健专业人员的反和教育.
- 尿液培养,抗生素使用,停留时间,急性护理转移和死亡率的数据是在干预前18个月和干预后16个月收集的.
主要成果:
- 这项干预措施导致尿路抗生素使用显著减少 (IRR 0.68;95% CI,0.59-0.79).
- 干预后,尿液培养率也下降了 (IRR 0.87;95% CI,0.67-1.12),尽管在统计学上并不显著.
- 没有观察到患者平均逗留时间,急性护理转移或死亡率的显著变化.
结论:
- BLADDER评分是一个安全有效的工具,用于加强诊断决策和抗菌药物管理.
- 实施BLADDER评分可以帮助减少无症状细菌尿症不必要的抗生素治疗.
- 这种方法支持老年人合理使用抗生素,减轻与抗菌素耐药性相关的风险.
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