AACに発表された、バロセロナにある総合病院のICUによるASPの効果。
Abstract
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Antimicrobial stewardship (AMS) program.
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Between January 1 and March 31, 2011, a program for optimizing the use of antimicrobials
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was implemented in the hospital.
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Prior to the application of the AMS program, each attending physician or medical team
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decided on which antimicrobials had to be administered to their patients and the
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duration of treatment. No restriction programs for the use of antimicrobials have been
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implemented before 2011. In the hospital and in the ICU, there were some guidelines
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for the use of antibiotics but these recommendations have not been subjected to
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audits or assessments of adherence.
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The AMS program included the following characteristics:
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a) establishment of a multidisciplinary working group with specialists in
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infectious diseases, pharmacy, microbiology, and intensive care medicine who were
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responsible for the design and implementation of the AMS program;
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b) development of a computer application for the specific prescription of antimicrobials which was
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added to the patient’s computerized medical record;
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c) selection of 10 antimicrobial agents, which due to their greater environmental and economic impact, underwent special control measures, including the need to justify their indications in writing
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through the application form of the program, compulsory detailed information of the
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duration of treatment, immediate information of the cost of prescription, and
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automatic discontinuation of drug administration on the day set by the prescriber
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physician, with reassessment of indications during the next 24-72 hours by a member
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of the working group.
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These antimicrobials were carbapenems (imipenem,meropenem), tigecycline, linezolid, voriconazole, candins (caspofungin, anidulafungin,micafungin), and lipid-associated amphotericin B (liposomal, lipid complex).
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In the ICU setting, an expert intensivist in infectious diseases was responsible for implementation
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of the program. Actions included daily review of antibiotics regimens of all patients
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during the shift change (8:00 AM, 3:00 PM, 9:00 PM), obligation to include the number
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of days of antimicrobial administration in the computerized clinical course record, and
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reasonable proposals of dose adjustment, de-escalation, or withdrawal in the daily
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clinical sessions of the ICU staff (2:00-3:30 PM).
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The AMS program was well accepted in the ICU setting, with no rejections by
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the ICU personnel. Details of the implementation of the recommendations were
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discussed at daily sessions and final decisions were taken by consensus of the ICU
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team. In case of disagreement, the expert’s opinion prevailed who had received
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empowerment by the medical director of the hospital and the chief of the ICU.
感想
シンプルな発表。ちなみに、ICUをUCIとアブストに記載しています。
図はイケてません。バックグランドにAPACHE2スコアがあるのは、素晴らしいですので、メインアウトカムを死亡率にしてはと思いました。

Hospitalist(ホスピタリスト) Vol.5 No.3 2017(特集:感染症2)
- 作者: 岡本耕,八重樫牧人
- 出版社/メーカー: メディカルサイエンスインターナショナル
- 発売日: 2017/10/02
- メディア: 雑誌
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