对侵袭性真菌感染的成年人抗真菌治疗使用的审计:一项前性观察性研究
Ankesh Gupta1, Immaculata Xess2, Manish Soneja1
1Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
Indian journal of medical microbiology
|December 21, 2024
概括
一项抗真菌审计显示,34%的患者使用药物低于最佳水平,突出了药物选择,剂量和治疗持续时间方面的问题. 这导致成本增加和药物不良反应,强调需要改进抗真菌管理.
科学领域:
- 临床药房 临床药房
- 传染性疾病 传染性疾病
- 药物经济学 药物经济学
背景情况:
- 侵入性真菌感染 (IFI) 需要适当的抗真菌治疗.
- 低于最佳的抗真菌使用可能导致治疗失败,药物不良反应 (ADRs) 和医疗保健成本增加.
- 抗真菌管理计划对于优化医疗保健机构中药物使用至关重要.
研究的目的:
- 评估IFI住院成年患者的全身抗真菌使用模式.
- 评估抗真菌处方的适当性,确定非最佳使用的原因,并量化相关的副作用.
- 确定非最佳抗真菌治疗的经济负担,以及抗真菌审计对管理的影响.
主要方法:
- 一个前性审计的系统性抗真菌使用在100名成年患者的IFIs在第三级护理中心.
- 数据收集包括患者人口统计学,临床特征,抗真菌剂,副作用以及使用预定义评分系统的治疗适当性.
- 基于IDSA和ECIL指南的理想治疗持续时间的分析和非最佳使用的经济影响的计算.
主要成果:
- 在66%的病例中实现了最佳的抗真菌使用;34%的病例由于药物选择,剂量,时间或持续时间不正确而表现出非最佳的使用.
- 常规处方的抗真菌药物包括沃里康纳 (35.1%),卡斯波丁 (23.1%),和脂质体安福特里辛B (20.1%),后者具有最高的ADR率 (81.4%).
- 非最佳治疗导致额外的经济负担约为13,841美元,其中39.7%的治疗日是非最佳的.
结论:
- 很大一部分 (34%) 的抗真菌药物使用是不理想的,需要进行干预以改善处方实践.
- 抗真菌审计在确定非最佳使用的原因,促进遵守指南和优化临床结果方面是有效的.
- 实施强有力的抗真菌管理可以最大限度地减少药物毒性,并减少与第三级护理中的IFI相关的经济负担.
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