Antimicrob Agents Ch:碳青酶烯类抗菌药管理计划危及患者安全?

2017-09-29 梁舒瑶 环球医学

2017年发表在《Antimicrob Agents Chemother》的一项由新加坡科学家进行的系统评价考察了碳青酶烯类抗菌药管理计划(ASPs)对患者结局的影响。

2017年发表在《Antimicrob Agents Chemother》的一项由新加坡科学家进行的系统评价考察了碳青酶烯类抗菌药管理计划(ASPs)对患者结局的影响。

ASPs旨在改善适当的抗菌药使用。然而,存在来自接受ASP干预负面结果的担忧,尤其是推荐广谱抗菌药降梯治疗或中断治疗时。在此,研究者评价了初级治疗提供者接受或拒绝针对不恰当碳青酶烯类使用的ASP干预时,对临床结局的影响。2011年7月至2014年12月,研究者根据ASP干预机构的指南,回顾性评价了所有被认为是不恰当的碳青酶烯类处方。评价了包括碳青酶烯类使用、住院时长、住院花费、30天再入院率以及死亡率在内的干预接受和结局。分析了两组的数据,其中一组的医师接受所有的干预(“接受”),另一组干预被拒绝(“拒绝”)。共有158个ASP干预,包括碳青酶烯类中断(35%),转换至窄谱抗菌药(32%),剂量优化(17%),进一步调查(包括影像和降钙素原,PCT)(11%),感染性疾病转诊(3%),抗菌药的中断(非碳青酶烯类)(1%),以及源控制(1%)。在220例唯一的患者中,101(45.9%)例患者的碳青酶烯类使用不恰当。与拒绝组相比,在接收组中观察到碳青酶烯类使用的显着降低(中位限定日剂量分别为,0.224 vs 0.668/1000患者-天;p<0.001)。与拒绝组(10例死亡,p=0.015)相比,接受组中(0)30天死亡率显着降低,但住院时长、住院花费或30天再入院率无差异。在多变量分析中,低血压与死亡率独立相关(比值比,5.25;95%置信区间,1.34~20.6)。在研究者所在机构中,在降低使用时,在临床结局方面,接受碳青酶烯类ASP干预不会危及患者安全。

原始出处:
Seah VXF, Ong RYL, Lim ASY, et al.Impact of a Carbapenem Antimicrobial Stewardship Program on Patient Outcomes.Antimicrob Agents Chemother. 2017;61(9). pii: e00736-17. doi: 10.1128/AAC.00736-17. Print 2017 Sep.

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    2017-10-09 xjy02
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    2017-11-15 grace5700
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    2018-01-24 wjywjy
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  7. [GetPortalCommentsPageByObjectIdResponse(id=2084272, encodeId=75ba20842e280, content=<a href='/topic/show?id=61f411e013b' target=_blank style='color:#2F92EE;'>#Micro#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11701, encryptionId=61f411e013b, topicName=Micro)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d59291, createdName=xjy02, createdTime=Mon Oct 09 02:33:00 CST 2017, time=2017-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1779496, encodeId=f6be1e79496e8, content=<a href='/topic/show?id=481a2094a9' target=_blank style='color:#2F92EE;'>#Agent#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2094, encryptionId=481a2094a9, topicName=Agent)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b05b180, createdName=grace5700, createdTime=Wed Nov 15 04:33:00 CST 2017, time=2017-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1857510, encodeId=6f5a185e5104d, content=<a href='/topic/show?id=3f48525849' target=_blank style='color:#2F92EE;'>#CRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5258, encryptionId=3f48525849, topicName=CRO)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c30265, createdName=jiafufeng@yaho, createdTime=Wed Jun 06 14:33:00 CST 2018, time=2018-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1779558, encodeId=0c041e7955879, content=<a href='/topic/show?id=0473209562' target=_blank style='color:#2F92EE;'>#agents#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2095, encryptionId=0473209562, topicName=agents)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1072181, createdName=wjywjy, createdTime=Wed Jan 24 13:33:00 CST 2018, time=2018-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2045135, encodeId=5a6420451351c, content=<a href='/topic/show?id=a0555302119' target=_blank style='color:#2F92EE;'>#患者安全#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53021, encryptionId=a0555302119, topicName=患者安全)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Fri Nov 24 16:33:00 CST 2017, time=2017-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1330609, encodeId=4632133060967, content=<a href='/topic/show?id=c6b455688d1' target=_blank style='color:#2F92EE;'>#抗菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55688, encryptionId=c6b455688d1, topicName=抗菌)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/2898B09F0DA89357D0D54A725E611AC7/100, createdBy=fdd32500040, createdName=ms7899726347904398, createdTime=Sun Oct 01 04:33:00 CST 2017, time=2017-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373039, encodeId=27fc13e303957, content=<a href='/topic/show?id=eb2555e176c' target=_blank style='color:#2F92EE;'>#抗菌药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=14, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55717, encryptionId=eb2555e176c, topicName=抗菌药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7e12358, createdName=lhlxtx, createdTime=Sun Oct 01 04:33:00 CST 2017, time=2017-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248813, encodeId=570724881340, content=谢谢分享.学习受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Fri Sep 29 14:04:10 CST 2017, time=2017-09-29, status=1, ipAttribution=)]
    2017-10-01 lhlxtx
  8. [GetPortalCommentsPageByObjectIdResponse(id=2084272, encodeId=75ba20842e280, content=<a href='/topic/show?id=61f411e013b' target=_blank style='color:#2F92EE;'>#Micro#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11701, encryptionId=61f411e013b, topicName=Micro)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d59291, createdName=xjy02, createdTime=Mon Oct 09 02:33:00 CST 2017, time=2017-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1779496, encodeId=f6be1e79496e8, content=<a href='/topic/show?id=481a2094a9' target=_blank style='color:#2F92EE;'>#Agent#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2094, encryptionId=481a2094a9, topicName=Agent)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b05b180, createdName=grace5700, createdTime=Wed Nov 15 04:33:00 CST 2017, time=2017-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1857510, encodeId=6f5a185e5104d, content=<a href='/topic/show?id=3f48525849' target=_blank style='color:#2F92EE;'>#CRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5258, encryptionId=3f48525849, topicName=CRO)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c30265, createdName=jiafufeng@yaho, createdTime=Wed Jun 06 14:33:00 CST 2018, time=2018-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1779558, encodeId=0c041e7955879, content=<a href='/topic/show?id=0473209562' target=_blank style='color:#2F92EE;'>#agents#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2095, encryptionId=0473209562, topicName=agents)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1072181, createdName=wjywjy, createdTime=Wed Jan 24 13:33:00 CST 2018, time=2018-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2045135, encodeId=5a6420451351c, content=<a href='/topic/show?id=a0555302119' target=_blank style='color:#2F92EE;'>#患者安全#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53021, encryptionId=a0555302119, topicName=患者安全)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Fri Nov 24 16:33:00 CST 2017, time=2017-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1330609, encodeId=4632133060967, content=<a href='/topic/show?id=c6b455688d1' target=_blank style='color:#2F92EE;'>#抗菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55688, encryptionId=c6b455688d1, topicName=抗菌)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/2898B09F0DA89357D0D54A725E611AC7/100, createdBy=fdd32500040, createdName=ms7899726347904398, createdTime=Sun Oct 01 04:33:00 CST 2017, time=2017-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373039, encodeId=27fc13e303957, content=<a href='/topic/show?id=eb2555e176c' target=_blank style='color:#2F92EE;'>#抗菌药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=14, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55717, encryptionId=eb2555e176c, topicName=抗菌药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7e12358, createdName=lhlxtx, createdTime=Sun Oct 01 04:33:00 CST 2017, time=2017-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248813, encodeId=570724881340, content=谢谢分享.学习受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Fri Sep 29 14:04:10 CST 2017, time=2017-09-29, status=1, ipAttribution=)]
    2017-09-29 清风拂面

    谢谢分享.学习受益匪浅

    0

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