治愈鞋底:一个微生物学驱动的电子健康记录算法和顺序设置,以减少在糖尿病足部感染中使用抗伪药,一个回顾性,观察性,准实验性研究
Antoinette Marie Acbo1, Naida Koura-Mola1, Terrence McSweeney1
1Department of Pharmacy, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Antimicrobial stewardship & healthcare epidemiology : ASHE
|March 31, 2025
概括
电子健康记录工具减少了针对糖尿病脚部感染 (DFI) 的抗伪体抗生素使用. 这种干预措施并没有增加死亡率或截肢率,这表明DFI管理得到了改进.
科学领域:
- 传染性疾病 传染性疾病
- 临床信息学 临床信息学
- 药理学 药理学是指药理学的学科.
背景情况:
- 糖尿病足部感染 (DFI) 经常接受广泛的抗伪体抗生素,尽管*Pseudomonas aeruginosa*的流行率很低.
- 一个多学科团队开发了一个电子健康记录 (EHR) 嵌入的治疗算法和顺序,以优化DFI的抗生素处方.
研究的目的:
- 评估EHR嵌入式治疗算法和顺序对DFI患者抗伪体抗生素使用的影响.
- 评估二次结果,包括停留时间,再接收率,死亡率,截肢和*Clostridioides difficile*感染.
主要方法:
- 一项多中心的准实验性研究比较了DFI患者在EHR干预之前和之后的实施情况.
- 包括接受抗生素DFI的成年患者;使用排除标准.
- 主要终点是抗伪体抗生素使用 (DOT/1000 DFI天).
主要成果:
- 在干预后,抗伪药使用显著下降 (360 vs 503 DOT/1000 DFI 天; P < 0.001).
- 经验反伪药的使用率从85.7%下降到72% (算法后) 和68.5% (订单后集).
- 30天死亡率和截肢率在各组中保持相似.
结论:
- 嵌入EHR的临床决策支持工具有效地减少了对DFI的不必要的抗伪抗生素处方.
- 这项干预措施改善了抗生素管理,但没有对患者的死亡率或截肢等结果产生不利影响.
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