优化针对急性穿孔尾炎的成年患者的抗生素管理:质量改善研究
Carlos Gallego-Navarro1, Jason Beckermann2, Maria E Linnaus2
1Program for Hypoplastic Left Heart Syndrome, Mayo Clinic, Rochester, Minnesota, USA.
Surgical infections
|April 3, 2025
概括
减少用于穿孔性尾炎的广泛抗生素的使用是可以实现的. 一个质量改进项目成功减少了piperacillin/tazobactam的使用,但没有增加手术部位感染或再入院.
科学领域:
- 手术传染病手术传染病
- 抗生素管理局 抗生素管理局
- 提高医疗保健的质量 改善医疗保健的质量
背景情况:
- 急性尾炎 (AA) 是一种常见的手术紧急情况,穿孔增加了患者的发病率和死亡率.
- 对AA的广泛抗生素使用很普遍,需要优化策略.
- 穿孔性尾炎需要仔细使用抗生素来预防并发症.
研究的目的:
- 评估质量改善倡议对穿孔性尾炎中广泛抗生素使用的影响.
- 评估抗生素处方模式的变化,特别是减少皮佩拉西林/塔扎巴克坦的使用.
- 确定减少广泛抗生素使用是否会影响手术部位感染 (SSIs) 和再入院率.
主要方法:
- 一个多站点质量改进项目专注于教育提供者和优化电子医疗记录 (EMR) 抗生素订单集.
- 干预措施包括鼓励使用塞夫特里亚克松加上美特罗尼达,并阻止用于穿孔性尾炎的皮佩拉西林/塔扎巴克坦.
- 一个子集分析比较了116名患有穿孔尾炎的患者干预前和干预后.
主要成果:
- 皮佩拉西林/塔扎巴克坦的使用率从62.2%下降到25.4% (p < 0.0001),而二和二的使用率则从8.9%上升到53.5%.
- 三十天再接收率相似 (15.6%对5.6%,p=0.104).
- 手术部位感染率 (表面,深部,器官空间) 和Clostridium difficile感染率在各组之间保持相似.
结论:
- 提供者教育和EMR订单优化可以有效地减少穿孔性尾炎的广泛抗生素使用.
- 这种方法可以实施,而不会对患者的结果产生不利影响,例如SSI或再录取.
- 这些发现支持在治疗急性穿孔性尾炎方面进行的抗菌药物管理工作.
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