一项试点干预措施,以改善门诊机构尿路感染的管理
Karl J Madaras-Kelly1,2, Trisha Nakasone3, Saba Maghari4
1Coll of Pharmacy, Idaho State Univ. Meridian, ID, USA.
Antimicrobial stewardship & healthcare epidemiology : ASHE
|December 25, 2025
概括
在退伍军人事务医疗中心实施了门诊性尿路感染 (UTI) 干预. 虽然该干预措施是可行的,但它在改善尿路感染管理方面表现出极小的有效性,特别是在男性占主导地位的人群中.
科学领域:
- 传染性疾病 传染性疾病
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 尿路感染 (UTI) 是常见的门诊感染,需要有效的管理策略.
- 抗生素管理对于打击抗菌素耐药性和优化尿路感染治疗至关重要.
- 退伍军人事务 (VA) 医疗保健系统为实施和评估大规模临床干预提供了一个独特的环境.
研究的目的:
- 描述基于CDC核心元素抗生素管理框架的门诊UTI干预的实施.
- 评估这项干预措施对紧急和初级保健机构中尿路感染管理指标的影响.
- 评估干预措施在以男性为主的退伍军人群体中的可行性和有效性.
主要方法:
- 采用了一种准实验性的追溯受控研究设计.
- 该干预涉及学术细节,审计反和更新的反射培养程序在8个VA医疗中心.
- 后勤回归和差异差异 (DID) 分析被用来比较干预和控制地点之间的尿路感染管理指标.
主要成果:
- 这项研究包括了超过435,000次的生殖泌尿道 (GU) 检查. 对GU投诉的总体抗生素处方率没有显著变化 (DID aRR 0.97).
- 对无并发性尿道感染 (UTI) 进行适当的治疗选择,在干预地点显著改善 (DID aRR 0.94).
- 对UTI的适当治疗持续时间也显著改善 (DID aRR 1.08),没有证据表明诊断转移或增加复诊次数.
结论:
- 在VA系统中,使用CDC框架实施门诊性尿路感染干预是可行的.
- 该干预措施在改善整体尿路感染管理方面表现出极小的有效性,在不复杂的尿路感染中,在适当的治疗选择和持续时间方面取得了显著的改善.
- 可能需要进一步的策略来增强尿路感染干预措施的影响,特别是在特定人群中,如主要是男性退伍军人.
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