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在学术医疗中心成功实施抗菌药物管理计划

发布日期:2017-12-28来源:原创发布人:梦缘徽州

背景:关注来自认证机构或联合委员会等监管机构以及医疗保险和医疗补助服务中心和疾病控制中心等监管机构的抗菌药物使用和感染预防,强调了持续开发抗菌药物的必要性全国医疗机构的管理计划。

方法:我们的机构利用美国2007年传染病协会和医疗保健流行病学协会的指导方针,指导其抗菌药物使用的评估,并制定了一个成功的抗菌药物管理计划。进行了三项基线评估。回顾性图表评估评估氟喹诺酮和碳青霉烯的配方限制,美罗培南的剂量优化程序,以及氟康唑和伏立康唑的静脉内至口服转化程序。

结果:约40%的左氧氟沙星订单没有在患者图表中被非正式使用的临床理由支持。为美罗培南撰写的命令中有百分之四十九未遵循剂量优化程序。建议在适当的时候将氟康唑和伏立康唑转换成口服治疗的机会。

结论:基线评估显示需要一个抗菌管理计划。本文概述了用于评估需求的计划,计划,实施和评估抗菌药物管理计划的影响。

Successful Implementation of an Antimicrobial Stewardship Program at an Academic Medical Center

Background: Focus on antimicrobial use and infection prevention from accrediting or regulatory bodies such as the Joint Commission, as well as regulatory agencies such as the Centers for Medicare and Medicaid Services and the Centers for Disease Control, has highlighted the need for continuing development of antimicrobial stewardship programs at healthcare facilities across the country. Methods: Our institution utilized the 2007 Infectious Diseases Society of America and the Society for Healthcare Epidemiology guidelines to direct the evaluation of its antimicrobial use and develop a successful antimicrobial stewardship program. Three baseline evaluations were conducted. Retrospective chart reviews evaluating formulary restrictions for fluroquinolones and carbepenems, a dosing optimization program for meropenem, and the intravenous to oral conversion program for fluconazole and voriconazole were completed. Results: Approximately 40% of orders for levofloxacin were not supported with a clinical justification for nonformulary use in the patient chart. Forty-nine percent of orders written for meropenem did not follow the dose optimization program. Opportunity for fluconazole and voriconazole to be converted to oral therapy when appropriate was suggested. Conclusion: The baseline evaluations revealed the need for an antimicrobial stewardship program. This article outlines the process used to assess need, plan, implement, and evaluate the impact of an antimicrobial stewardship program.


KKeywords antimicrobial stewardshipantimicrobial resistanceantimicrobial useantibiotics