在三个医疗中心实施诊断管理,以改善尿路感染和抗生素的使用
Kimberly C Claeys1,2, Clayton H Brown2, Lisa Pineles2
1University of Maryland School of Pharmacy, Baltimore, MD, USA.
概括
条件反射尿培养显著减少了退伍军人尿路感染 (UTI) 的抗生素使用. 这种诊断管理策略建议首先在医疗保健系统中实施.
科学领域:
- 传染性疾病 传染性疾病
- 医疗保健管理的管理
- 临床诊断 临床诊断 临床诊断
背景情况:
- 尿路感染 (UTI) 的过度诊断和过度使用抗生素很普遍,特别是在老年人群中,如退伍军人.
- 诊断管理干预可以减轻过度诊断和过度治疗,但最佳实施策略需要进一步研究.
研究的目的:
- 评估多个VA医院的尿路感染诊断管理干预措施的有效性和实施情况.
- 评估不同阶段的干预措施的影响:订购,处理 (条件反射尿培养) 和报告.
主要方法:
- 在三个VA医院进行了一项多中心混合型二型有效性实施研究.
- 干预包括条件反射尿液培养,以及订购或报告阶段的变化.
- 主要结局是每次入院的住院尿路感染抗生素治疗日 (DOT).
主要成果:
- 在一家医院进行条件反射尿培养,导致尿路感染抗生素DOTs减少了39.5%.
- 这种干预措施还减少了订购的 (22.8%) 和执行的 (38.9%) 尿液培养.
- 在命令或报告其他地点的干预措施时,没有观察到尿路感染点滴的显著变化;没有注意到二次细菌病的增加.
结论:
- 条件反射尿培养表明,尿路感染抗生素DOT和尿培养利用率大幅下降.
- 启动尿液培养诊断管理的医疗保健系统应优先实施条件反射尿液培养.
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