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Clinical Subphenotypes of Staphylococcus aureus Bacteremia. 金黄色葡萄球菌菌血症的临床亚型。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-11-22 DOI: 10.1093/cid/ciae338
Maaike C Swets, Zsuzsa Bakk, Annette C Westgeest, Karla Berry, George Cooper, Wynne Sim, Rui Shian Lee, Tze Yi Gan, William Donlon, Antonia Besu, Emily Heppenstall, Luke Tysall, Simon Dewar, Mark de Boer, Vance G Fowler, David H Dockrell, Guy E Thwaites, Miquel Pujol, Natàlia Pallarès, Cristian Tebé, Jordi Carratalà, Alexander Szubert, Geert H Groeneveld, Clark D Russell

Background: Staphylococcus aureus bacteremia (SAB) is a clinically heterogeneous disease. The ability to identify subgroups of patients with shared traits (subphenotypes) is an unmet need to allow patient stratification for clinical management and research. We aimed to test the hypothesis that clinically relevant subphenotypes can be reproducibly identified among patients with SAB.

Methods: We studied 3 cohorts of adults with monomicrobial SAB: a UK retrospective observational study (Edinburgh cohort, n = 458), the UK ARREST trial (n = 758), and the Spanish SAFO trial (n = 214). Latent class analysis was used to identify subphenotypes using routinely collected clinical data without considering outcomes. Mortality and microbiologic outcomes were then compared between subphenotypes.

Results: Included patients had predominantly methicillin-susceptible SAB (1366 of 1430, 95.5%). We identified 5 distinct, reproducible clinical subphenotypes: (A) SAB associated with older age and comorbidity, (B) nosocomial intravenous catheter-associated SAB in younger people without comorbidity, (C) community-acquired metastatic SAB, (D) SAB associated with chronic kidney disease, and (E) SAB associated with injection drug use. Survival and microbiologic outcomes differed between the subphenotypes. Mortality was highest in subphenotype A and lowest in subphenotypes B and E. Microbiologic outcomes were worse in subphenotype C. In a secondary analysis of the ARREST trial, adjunctive rifampicin was associated with increased mortality in subphenotype B and improved microbiologic outcomes in subphenotype C.

Conclusions: We have identified reproducible and clinically relevant subphenotypes within SAB and provide proof of principle of differential treatment effects. Through clinical trial enrichment and patient stratification, these subphenotypes could contribute to a personalized medicine approach to SAB.

背景:金黄色葡萄球菌菌血症(SAB)是一种临床异质性疾病。识别具有共同特征(亚表型)的患者亚群的能力是一项尚未满足的需求,这种能力可对患者进行分层,以便于临床管理和研究。我们的目的是验证一个假设,即可以在 SAB 患者中重复识别出与临床相关的亚表型:我们研究了三组住院成人单微生物SAB患者:英国回顾性观察研究(爱丁堡队列,n=458)、英国ARREST随机试验(n=758)和西班牙SAFO随机试验(n=214)。在不考虑结果的情况下,使用常规收集的临床数据进行潜类分析以确定亚型。然后对不同亚型的死亡率和微生物学结果进行比较:纳入的患者主要患有对甲氧西林敏感的 SAB(1366/1430,95.5%)。我们发现了五种不同的、可重复的临床亚型:(A) 与高龄和合并症相关的 SAB,(B) 在无合并症的年轻人中发生的与鼻腔静脉导管相关的 SAB,(C) 社区获得的转移性 SAB,(D) 与慢性肾病相关的 SAB,以及 (E) 与注射吸毒相关的 SAB。不同亚型的存活率和微生物学结果各不相同。亚型 A 的 84 天死亡率最高,亚型 B 和亚型 E 最低。亚型 C 的微生物学结果较差。在 ARREST 试验的二次分析中,辅助利福平与亚型 B 的 84 天死亡率增加和亚型 C 的微生物学结果改善有关:我们在 SAB 中发现了可重复的临床相关亚型,并提供了不同治疗效果的原理证明。通过丰富临床试验和对患者进行分层,这些亚型可为 SAB 的个性化医疗方法做出贡献。
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引用次数: 0
Preventability of Hospital Deaths in Patients With Non-Ventilator Hospital-Acquired Pneumonia. 非呼吸机医院获得性肺炎患者在医院死亡的可预防性。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-11-22 DOI: 10.1093/cid/ciae418
Alexander M Tatara, Anna Apostolopoulou, Anna A Agan, Laura DelloStritto, Chanu Rhee, Michael Klompas

Background: Crude and adjusted mortality rates for patients with non-ventilator hospital-acquired pneumonia (NV-HAP) are among the highest of all healthcare-associated infections, leading to calls for greater prevention. Patients prone to NV-HAP, however, tend to be severely ill at baseline, making it unclear whether their high mortality rates are due to NV-HAP, their underlying conditions, or both.

Methods: Two infectious disease physicians conducted detailed medical record reviews on 150 randomly selected adults from 4 hospitals who died in-hospital following an NV-HAP event between April 2016 and May 2021. Reviewers abstracted risk factors, estimated the preventability of NV-HAP, identified causes of death, and adjudicated the preventability of death.

Results: The patients' median age was 69.3 (IQR, 60.7-77.4) years and 43.3% were female. Comorbidities were common: 57% had cancer, 30% chronic kidney disease, 29% chronic lung disease, and 27% had heart failure. At least 1 hospice-eligible condition was present before NV-HAP in 54% and "Do Not Resuscitate" orders in 24%. Most (99%) had difficult-to-modify NV-HAP risk factors: 76% altered mental status, 35% dysphagia, and 27% nasogastric/orogastric tubes. NV-HAP was deemed possibly or probably preventable in 21% and hospital death likely or very likely preventable in 8.6%.

Conclusions: Most patients who die following NV-HAP have multiple, severe underlying comorbidities and difficult-to-modify risk factors for NV-HAP. Only 1 in 5 NV-HAPs that culminated in death and 1 in 12 deaths following NV-HAP were judged potentially preventable. This does not diminish the importance of NV-HAP prevention programs but informs expectations about the potential magnitude of their impact on hospital deaths.

背景:在所有医疗相关感染中,非呼吸机医院获得性肺炎(NV-HAP)患者的粗死亡率和调整后死亡率最高,因此呼吁加强预防。然而,易患非呼吸器医院获得性肺炎的患者在基线时往往病情严重,因此尚不清楚他们的高死亡率是由非呼吸器医院获得性肺炎、潜在疾病还是两者共同造成的:两名传染病医生对 4 家医院随机抽取的 150 名成人进行了详细的病历审查,这些成人在 2016 年 4 月至 2021 年 5 月期间因 NV-HAP 事件而死于院内。审查人员摘录了风险因素,估计了 NV-HAP 的可预防性,确定了死亡原因,并对死亡的可预防性进行了裁定:患者的中位年龄为 69.3 岁(IQR 60.7-77.4),43.3% 为女性。合并症很常见:57%患有癌症,30%患有慢性肾病,29%患有慢性肺病,27%患有心力衰竭。54%的患者在接受 NV-HAP 治疗前至少患有一种符合临终关怀条件的疾病,24%的患者在接受 NV-HAP 治疗前下达了 "禁止复苏 "指令。大多数患者(99%)存在难以改变的 NV-HAP 风险因素:76%的患者存在精神状态改变,35%的患者存在吞咽困难,27%的患者存在鼻胃管/胃管。21%的患者被认为NV-HAP可能或很可能可以预防,8.6%的患者被认为住院死亡可能或很可能可以预防:结论:大多数死于 NV-HAP 的患者都有多种严重的基础并发症和难以改变的 NV-HAP 风险因素。只有五分之一最终导致死亡的 NV-HAP 和十二分之一在 NV-HAP 后死亡的患者被判定为可能可以预防。这并没有降低 NV-HAP 预防计划的重要性,而是让人们了解了这些计划对医院死亡的潜在影响程度。
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引用次数: 0
Correction to: The Growing Threat of NDM-Producing Escherichia coli With Penicillin-Binding Protein 3 Mutations in the United States-Is There a Potential Role for Durlobactam? 更正:美国产生青霉素结合蛋白 3 突变的 NDM 大肠杆菌的威胁日益严重--杜鲁巴坦有潜在作用吗?
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-11-22 DOI: 10.1093/cid/ciae414
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引用次数: 0
A 25-Year-Old Man With Fever, Diarrhea, and Shock. 一名发烧、腹泻和休克的 25 岁男子。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-11-22 DOI: 10.1093/cid/ciae322
Albert Wu, Jeffrey Levine, Dennise Otero Espinal, Zachary Pek
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引用次数: 0
State-of-the-Art Review: Ocular Infections. 最新评论:眼部感染。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-11-22 DOI: 10.1093/cid/ciae433
Miriam B Barshak, Marlene L Durand, Akash Gupta, Amir M Mohareb, Thomas H Dohlman, George N Papaliodis
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引用次数: 0
An Unusual Case of Forehead Swelling in a Geriatric Patient. 一名老年患者额头肿胀的罕见病例
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-11-22 DOI: 10.1093/cid/ciae299
Samuel Baumgart, Genevieve McKew
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引用次数: 0
Type 1 Human Immunodeficiency Virus (HIV-1) Incidence, Adherence, and Drug Resistance in Individuals Taking Daily Emtricitabine/Tenofovir Disoproxil Fumarate for HIV-1 Pre-exposure Prophylaxis: Pooled Analysis From 72 Global Studies. 每日服用恩曲他滨/富马酸替诺福韦二吡呋酯进行 HIV-1 暴露前预防的人群中的 HIV-1 发生率、依从性和耐药性:来自 72 项全球研究的汇总分析。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-11-22 DOI: 10.1093/cid/ciae143
Raphael J Landovitz, Li Tao, Juan Yang, Melanie de Boer, Christoph Carter, Moupali Das, Jared M Baeten, Albert Liu, Karen W Hoover, Connie Celum, Beatriz Grinsztejn, Sheldon Morris, Darrell P Wheeler, Kenneth H Mayer, Sarit A Golub, Linda-Gail Bekker, Souleymane Diabaté, Elske Hoornenborg, Janet Myers, Ashley A Leech, Sheena McCormack, Philip A Chan, Michael Sweat, Lynn T Matthews, Robert Grant

Background: Oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate (F/TDF) has high efficacy against HIV-1 acquisition. Seventy-two prospective studies of daily oral F/TDF PrEP were conducted to evaluate HIV-1 incidence, drug resistance, adherence, and bone and renal safety in diverse settings.

Methods: HIV-1 incidence was calculated from incident HIV-1 diagnoses after PrEP initiation and within 60 days of discontinuation. Tenofovir concentrations in dried blood spots (DBS), drug resistance, and bone/renal safety indicators were evaluated in a subset of studies.

Results: Among 17 274 participants, there were 101 cases with new HIV-1 diagnosis (.77 per 100 person-years; 95% confidence interval [CI]: .63-.94). In 78 cases with resistance data, 18 (23%) had M184I or V, 1 (1.3%) had K65R, and 3 (3.8%) had both mutations. In 54 cases with tenofovir concentration data from DBS, 45 (83.3%), 2 (3.7%), 6 (11.1%), and 1 (1.9%) had average adherence of <2, 2-3, 4-6, and ≥7 doses/wk, respectively, and the corresponding incidence was 3.9 (95% CI: 2.9-5.3), .24 (.060-.95), .27 (.12-.60), and .054 (.008-.38) per 100 person-years. Adherence was low in younger participants, Hispanic/Latinx and Black participants, cisgender women, and transgender women. Bone and renal adverse event incidence rates were 0.69 and 11.8 per 100 person-years, respectively, consistent with previous reports.

Conclusions: Leveraging the largest pooled analysis of global PrEP studies to date, we demonstrate that F/TDF is safe and highly effective, even with less than daily dosing, in diverse clinical settings, geographies, populations, and routes of HIV-1 exposure.

背景:使用恩曲他滨/富马酸替诺福韦二吡呋酯(F/TDF)口服暴露前预防疗法(PrEP)可有效预防HIV-1感染。我们开展了 72 项每日口服 F/TDF PrEP 的前瞻性研究,以评估不同环境下的 HIV-1 发生率、耐药性、依从性以及骨骼和肾脏安全性。在部分研究中评估了干血斑(DBS)中替诺福韦的浓度、耐药性以及骨骼/肾脏安全指标:在 17 274 名参与者中,有 101 例新确诊 HIV-1(每 100 人年 0.77 例;95% CI 0.63-0.94)。在 78 例有耐药性数据的病例中,18 例(23%)有 M184I 或 V 突变,1 例(1.3%)有 K65R 突变,3 例(3.8%)有两种突变。在 54 例有替诺福韦浓度数据的 DBS 病例中,45 例(83.3%)、2 例(3.7%)、6 例(11.1%)和 1 例(1.9%)的平均依从性为结论:通过对迄今为止规模最大的全球 PrEP 研究进行汇总分析,我们证明了 F/TDF 在不同的临床环境、地域、人群和 HIV-1 暴露途径中都是安全、高效的,即使不是每天给药。
{"title":"Type 1 Human Immunodeficiency Virus (HIV-1) Incidence, Adherence, and Drug Resistance in Individuals Taking Daily Emtricitabine/Tenofovir Disoproxil Fumarate for HIV-1 Pre-exposure Prophylaxis: Pooled Analysis From 72 Global Studies.","authors":"Raphael J Landovitz, Li Tao, Juan Yang, Melanie de Boer, Christoph Carter, Moupali Das, Jared M Baeten, Albert Liu, Karen W Hoover, Connie Celum, Beatriz Grinsztejn, Sheldon Morris, Darrell P Wheeler, Kenneth H Mayer, Sarit A Golub, Linda-Gail Bekker, Souleymane Diabaté, Elske Hoornenborg, Janet Myers, Ashley A Leech, Sheena McCormack, Philip A Chan, Michael Sweat, Lynn T Matthews, Robert Grant","doi":"10.1093/cid/ciae143","DOIUrl":"10.1093/cid/ciae143","url":null,"abstract":"<p><strong>Background: </strong>Oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate (F/TDF) has high efficacy against HIV-1 acquisition. Seventy-two prospective studies of daily oral F/TDF PrEP were conducted to evaluate HIV-1 incidence, drug resistance, adherence, and bone and renal safety in diverse settings.</p><p><strong>Methods: </strong>HIV-1 incidence was calculated from incident HIV-1 diagnoses after PrEP initiation and within 60 days of discontinuation. Tenofovir concentrations in dried blood spots (DBS), drug resistance, and bone/renal safety indicators were evaluated in a subset of studies.</p><p><strong>Results: </strong>Among 17 274 participants, there were 101 cases with new HIV-1 diagnosis (.77 per 100 person-years; 95% confidence interval [CI]: .63-.94). In 78 cases with resistance data, 18 (23%) had M184I or V, 1 (1.3%) had K65R, and 3 (3.8%) had both mutations. In 54 cases with tenofovir concentration data from DBS, 45 (83.3%), 2 (3.7%), 6 (11.1%), and 1 (1.9%) had average adherence of <2, 2-3, 4-6, and ≥7 doses/wk, respectively, and the corresponding incidence was 3.9 (95% CI: 2.9-5.3), .24 (.060-.95), .27 (.12-.60), and .054 (.008-.38) per 100 person-years. Adherence was low in younger participants, Hispanic/Latinx and Black participants, cisgender women, and transgender women. Bone and renal adverse event incidence rates were 0.69 and 11.8 per 100 person-years, respectively, consistent with previous reports.</p><p><strong>Conclusions: </strong>Leveraging the largest pooled analysis of global PrEP studies to date, we demonstrate that F/TDF is safe and highly effective, even with less than daily dosing, in diverse clinical settings, geographies, populations, and routes of HIV-1 exposure.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"1197-1207"},"PeriodicalIF":8.2,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7616831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140130884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
COVID-19: Find the Right Questions to be Answered. COVID-19:找到需要回答的正确问题。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-11-22 DOI: 10.1093/cid/ciae078
Andrea Giacomelli, Spinello Antinori, Andrea Gori, Alessandro Cozzi-Lepri
{"title":"COVID-19: Find the Right Questions to be Answered.","authors":"Andrea Giacomelli, Spinello Antinori, Andrea Gori, Alessandro Cozzi-Lepri","doi":"10.1093/cid/ciae078","DOIUrl":"10.1093/cid/ciae078","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"1322-1323"},"PeriodicalIF":8.2,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139897937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Revisiting the Evidence Base That Informs the Use of Adjunctive Therapy for Enterococcus faecalis Endocarditis: A Systematic Review and Meta-Analysis. 重新审视使用粪肠球菌心内膜炎辅助疗法的证据基础:系统回顾与元分析》。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-11-22 DOI: 10.1093/cid/ciae379
Connor Prosty, Mark Sorin, Khaled Katergi, Roy Khalaf, Clare Fogarty, Malick Turenne, Todd C Lee, Emily G McDonald

Background: Guidelines recommend adjunctive gentamicin for the treatment of Enterococcus faecalis infective endocarditis (EFIE) despite a risk of toxicity. We sought to revisit the evidence for adjunctive therapy in EFIE and to synthesize the comparative safety and effectiveness of aminoglycosides versus ceftriaxone by systematic review and meta-analysis.

Methods: For historical context, we reviewed seminal case series and in vitro studies on the evolution from penicillin monotherapy to modern-day regimens for EFIE. Next, we searched MEDLINE and Embase from inception to 16 January 2024 for studies of EFIE that compared adjunctive aminoglycosides versus ceftriaxone or adjunctive versus monotherapy. Where possible, clinical outcomes were compared between regimens using random effects meta-analysis. Otherwise, data were narratively summarized.

Results: The meta-analysis was limited to 10 observational studies at high risk of bias (911 patients). Relative to adjunctive ceftriaxone, gentamicin had similar all-cause mortality (risk difference [RD], -0.8%; 95% confidence interval [CI], -5.0 to 3.5), relapse (RD, -0.1%; 95% CI, -2.4 to 2.3), and treatment failure (RD, 1.1%; 95% CI, -1.6 to 3.7) but higher discontinuation due to toxicity (RD, 26.3%; 95% CI, 19.8 to 32.7). The 3 studies that compared adjunctive therapy to monotherapy included only 30 monotherapy patients, and heterogeneity precluded meta-analysis.

Conclusions: Adjunctive ceftriaxone appeared to be equally effective and less toxic than gentamicin for the treatment of EFIE. The existing evidence does not clearly establish the superiority of either adjunctive therapy or monotherapy. Pending randomized evidence, if adjunctive therapy is to be used, ceftriaxone appears to be a reasonable option.

背景:尽管存在毒性风险,但现行指南仍建议在治疗粪肠球菌感染性心内膜炎(EFIE)时辅助使用庆大霉素。我们试图重新审视 EFIE 辅助治疗的证据,并通过系统回顾和荟萃分析综合比较氨基糖苷类药物与头孢曲松辅助治疗的安全性和有效性:为了了解历史背景,我们回顾了开创性的病例系列研究和体外研究,这些研究为从青霉素单药治疗到现代 EFIE 治疗方案的演变提供了信息。接下来,我们检索了从开始到2024年1月16日的MEDLINE和Embase中有关EFIE的研究,比较了1)辅助氨基糖苷类药物与头孢曲松或2)辅助疗法与单一疗法。在可能的情况下,通过随机效应荟萃分析比较不同治疗方案的临床结果。否则,对数据进行叙述性总结:系统综述和荟萃分析的结果仅限于10项观察性研究,共计911名患者。所有研究均存在高偏倚风险。相对于辅助头孢曲松,庆大霉素的全因死亡率(风险差异[RD]=-0.8%,95%置信区间[95%CI]=-5.0,3.5)、复发率(RD=-0.1%,95%CI=-2.4,2.3)和治疗失败率(RD=1.1%,95%CI=-1.6,3.7)相似,但因毒性而停药的比例更高(RD=26.3%,95%CI=19.8,32.7)。将辅助疗法与单一疗法进行比较的3项研究仅包括30名单一疗法患者,异质性排除了荟萃分析:结论:与庆大霉素相比,头孢曲松的辅助疗法似乎对治疗EFIE同样有效,且毒性较小。现有证据并未明确证实辅助疗法或单一疗法的优越性。在没有随机证据之前,如果要使用辅助疗法,头孢曲松似乎是一个合理的选择。
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引用次数: 0
Long-term Effectiveness of Financial Incentives for Not Prescribing Unnecessary Antibiotics to Children with Acute Respiratory and Gastrointestinal Infections: A Japan’s Nationwide Quasi-Experimental Study 不向急性呼吸道和胃肠道感染患儿开具不必要抗生素处方的经济激励措施的长期效果:日本全国性准实验研究
IF 11.8 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-11-22 DOI: 10.1093/cid/ciae577
Yusuke Okubo, Kazuhiro Uda, Isao Miyairi
Background To address antibiotic overuse, the Japanese government implemented a novel financial incentive policy in 2018. The policy enables eligible healthcare facilities to claim 800 JPY (≈5.7 USD) per case wherein a rationale to not prescribe antibiotics is offered to children aged &lt;3 years with acute upper respiratory tract infections or gastroenteritis. Although the short-term effect of this policy was observed in our previous study, its long-term effects have not been evaluated nationwide. Methods We conducted a quasi-experimental study using a staggered difference-in-differences design with propensity score matching. Data from 165,113 children born between April 2017 and March 2019 were extracted from two nationwide administrative databases. The study tracked these children until May 2022, comparing those exposed to the policy with those who were not. Results The introduction of financial incentives led to a 44.9% reduction (95%CI, 41.1% to 47.7%) in total antibiotic prescriptions within the first month and 19.5% reduction (95%CI, 8.7% to 29.1%) over 48 months. Broad-spectrum antibiotic use also decreased by 24.4% (95%CI, 14.0% to 33.6%) over the same period. The policy did not result in increased hospitalizations, after-hours visits, or healthcare costs, but was associated with a slight increase in the number of office visits. A dose-response relationship was observed, with reductions in antibiotic use leveling off after approximately five incentives. Conclusions Financial incentives effectively reduced antibiotic prescriptions in children without adverse health outcomes, demonstrating sustained benefits over four years. This antimicrobial stewardship intervention offers a scalable model for other countries aiming to curb antibiotic overuse and combat antimicrobial resistance.
背景 为解决抗生素过度使用问题,日本政府于 2018 年实施了一项新颖的财政激励政策。该政策使符合条件的医疗机构能够为每例不开抗生素处方的病例索赔 800 日元(约合 5.7 美元),这些病例是年龄在 3 岁以上、患有急性上呼吸道感染或肠胃炎的儿童。虽然在我们之前的研究中观察到了这一政策的短期效果,但尚未在全国范围内对其长期效果进行评估。方法 我们采用交错差分设计和倾向得分匹配法进行了一项准实验研究。我们从两个全国性的行政数据库中提取了 2017 年 4 月至 2019 年 3 月间出生的 165 113 名儿童的数据。该研究对这些儿童进行了跟踪,直至 2022 年 5 月,并对那些接触了该政策的儿童与那些没有接触该政策的儿童进行了比较。结果 采用经济激励措施后,抗生素处方总量在第一个月内减少了 44.9%(95%CI,41.1% 至 47.7%),在 48 个月内减少了 19.5%(95%CI,8.7% 至 29.1%)。同期,广谱抗生素的使用也减少了 24.4%(95%CI,14.0% 至 33.6%)。该政策并未导致住院、下班后就诊或医疗费用的增加,但与就诊次数的轻微增加有关。观察到了剂量-反应关系,抗生素使用量的减少在大约五次激励后趋于平稳。结论 经济激励措施有效减少了儿童的抗生素处方用量,且不会对健康造成不良影响,并在四年内持续产生效益。这种抗菌药物管理干预措施为其他国家遏制抗生素过度使用和抗菌药物耐药性提供了一种可推广的模式。
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Clinical Infectious Diseases
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