摘要
目的:2004年,美国传染病学会(infectious diseases society of America,IDSA)发布了门诊胃肠外抗菌药物治疗(outpatient parenteral antimicrobial therapy,OPAT)监测指南,但并未对该指南的应用情况进行评估,因此,评估医院的内科医师对该指南的遵循情况。方法:选取2012年10月—2013年10月间接受OPAT超过1年的患者资料为对照组,并经感染科(infectious diseases,ID)医师监测患者30例;病例组为未经ID医师(非ID医师)监测的19例患者;剔除接受OPAT少于3 d的患者,检测指标包括对监测指南的依从性、万古霉素和氨基糖苷类抗菌药物的最佳目标血药浓度;比较非ID医师与ID医师监测上述指标的差异。结果:ID医师监测的30例患者的各项指标与非ID医师相比,非ID医师监测19例患者实施OPAT对指南的依从性更低(35.9%vs 68.3%,P<0.05),在治疗药物浓度监测过程中,病例组6例患者和对照组10例患者采用万古霉素和氨基糖苷类抗菌药物治疗的目标血药浓度的百分率经组间比较其差异无统计学意义(57.1%vs 68.4%,P>0.05)。结论:与ID医师相比,非ID医师更不愿遵循IDSA制定的OPAT监测指南,还需进一步探讨临床药师对预防OPAT不良事件的发生。
Objective： In 2004,the Infectious Diseases Society of America（IDSA） published monitoring guidelines for outpatient parenteral antimicrobial therapy（OPAT）,but no assessment of their utilization was reported.Therefore,we evaluated adherence to these recommendations by physicians in Maternity and Child Health Care Hospital.Methods： We performed a retrospective case-control study of patients who received OPAT over 1 year in Maternity and Child Health Care Hospital.Controls were patients treated by an infectious diseases（ID） physician,and cases were those without an ID physician.Patients were excluded if they received fewer than 3 days of OPAT.Two outcomes were measured： adherence to guidelines on monitoring and attainment of goal vancomycin and aminoglycoside serum concentrations when appropriate.The results for non-ID physicians were compared to ID physicians.Results： 30 patients were included in the retrospective study.Compared with patients who had ID physician supervision,the non-ID physicians who prescribed OPAT for 19 patients had lower adherence to monitoring recommendations（35.9% vs 68.3%,P0.05）.No difference could be detected in achieving the goal of vancomycin and aminoglycoside serum concentrations for the6 cases and 10 controls requiring therapeutic drug monitoring（57.1% vs 68.4%,respectively,P0.05）.Conclusion：Compared with ID physicians,non-ID physicians are more reluctant to follow the OPAT monitoring guidelines established by IDSA.It is also necessary to further explore the prevention of adverse OPAT events by clinical pharmacists.
作者
陈娜
谭秋荣
邓倩
李莉明
蒋涛
CHEN Na;TAN Qiu-rong;DENG Qian;LI Li-ming;JIANG Tao(Changsha Maternity and Child Health Care Hospital, Changsha 410007, China;The No. 1 Hospital Affiliated to Hunan University of Traditional Chinese Medicine, Changsha 410014, China)
出处
《抗感染药学》
2018年第5期767-771,共5页
Anti-infection Pharmacy
关键词
胃肠外
抗菌药物
监测
门诊患者
parenteral
antibiotic
monitoring
out-patient
