在一个大型学术医疗中心实施更新的腹膜内感染指南
Casey Smiley1, Jessica Rizzuto2, Nicola White2,3
1Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Open forum infectious diseases
|September 10, 2024
概括
电子临床决策支持工具成功更新了羊膜内感染 (IAI) 抗生素协议,增加了piperacillin-tazobactam的使用. 这一变化改善了IAI的经验性抗生素选择,而不会对患者安全结果产生负面影响.
科学领域:
- 产科和妇科 产科和妇科
- 传染性疾病 传染性疾病
- 临床药房 临床药房
背景情况:
- 内感染 (IAI) 影响2%-5%的怀孕,导致显著的孕产妇和新生儿发病率.
- 目前的第一线治疗方法,如安培素和 gentamicin 面临由于毒性,易感性变化和抗药性增加的挑战.
- 范德比尔特大学医学中心为了应对这些担忧,修订了其IAI抗生素战略.
研究的目的:
- 评估实施 piperacillin-tazobactam 作为内感染 (IAI) 主要抗生素的影响.
- 评估电子临床决策支持工具 (eCDST) 在推动IAI抗生素管理方面的有效性.
- 为了确定抗生素治疗方案的变化是否影响了患者的安全结果.
主要方法:
- 替代组合安培素, gentamicin 和 clindamycin 与 piperacillin-tazobactam 进行机构 IAI 治疗.
- 利用了电子临床决策支持工具 (eCDSTs) 与强制功能和自动化策略.
- 进行中断时间序列分析以评估抗生素使用变化 (DOT/1000PDP) 和临床结果的回归分析.
主要成果:
- 皮佩拉西林-塔扎巴克坦的使用在实施后增加了1.9DOT/1000PDP.
- 皮素,热胺素和克林达胺素的使用减少了-2.5DOT/1000PDP.
- 没有观察到住院时间,反复使用抗生素或30天再入院率的显著变化.
结论:
- 强迫eCDST功能变化,加上利益相关者教育,有效地转移了IAI的经验性抗生素选择.
- 更新的抗生素策略成功地改善了处方模式,而不会影响患者的安全.
- 这表明了在临床实践中实施抗生素管理变革的成功模式.
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