长期护理机构中与抗生素使用相关的居民、开处方者和设施层面的因素:定量研究的系统性回顾

Aurélie Bocquier, Berkehan Erkilic, Martin Babinet, Céline Pulcini, Nelly Agrinier
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引用次数: 0

摘要

长期护理机构(LTCF)需要开展抗菌药物管理计划,以解决抗菌药物耐药性问题。我们旨在确定与长期护理设施中抗生素使用相关的因素。这些信息将有助于指导抗菌药物管理计划。我们对从 PubMed、Cochrane Library、Embase、APA PsycArticles、APA PsycINFO、APA PsycTherapy、ScienceDirect 和 Web of Science 检索到的研究进行了系统性回顾。我们纳入了调查抗生素使用相关因素(即医护人员开具抗生素处方、LTCF 员工使用抗生素或居民使用抗生素)的定量研究。研究对象为 LTCF 居民、其家人和/或护理人员。我们对研究结果进行了定性叙事综合。在筛选出的 7591 条记录中,我们收录了 57 篇文章。大多数研究采用纵向设计(n = 34/57),调查了居民层面的因素(n = 29/57)和/或设施层面的因素(n = 32/57),而处方层面的因素较少(n = 8/57)。研究包括两类结果:抗生素处方总量(n = 45/57)和不适当抗生素处方(n = 10/57);有两项研究包括两类结果。与抗生素处方量较高相关的住院患者因素包括:合并症(8 项研究中有 5 项对这一因素进行了调查,并发现其具有统计学意义)、感染史(n = 5/6)、潜在感染迹象(如发烧,n = 4/6)、尿培养/滴定结果呈阳性(n = 3/4)、留置导尿管(n = 12/14)以及住院患者/家属要求使用抗生素(n = 1/1)。在设施层面,抗生素处方量与员工流动率(n = 1/1)和下班后医生出诊率(n = 1/1)呈正相关,与 LTCF 聘用现场协调医生(n = 1/1)呈负相关。在处方开具者层面,抗生素处方较多与前一年抗生素处方率较高有关(n = 1/1)。作为抗菌药物管理计划的一部分,改善感染预防和控制以及诊断方法仍是减少长者照护中心抗生素处方的关键步骤。一旦研究结果得到进一步证实,实施机构改革以限制人员流动,确保有专业人员负责抗菌药物管理活动,以及改善长者照护中心与外部处方者之间的合作,都可能有助于减少抗生素处方。
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Resident-, prescriber-, and facility-level factors associated with antibiotic use in long-term care facilities: a systematic review of quantitative studies
Antimicrobial stewardship programmes are needed in long-term care facilities (LTCFs) to tackle antimicrobial resistance. We aimed to identify factors associated with antibiotic use in LTCFs. Such information would be useful to guide antimicrobial stewardship programmes. We conducted a systematic review of studies retrieved from PubMed, Cochrane Library, Embase, APA PsycArticles, APA PsycINFO, APA PsycTherapy, ScienceDirect and Web of Science. We included quantitative studies that investigated factors associated with antibiotic use (i.e., antibiotic prescribing by health professionals, administration by LTCF staff, or use by residents). Participants were LTCF residents, their family, and/or carers. We performed a qualitative narrative synthesis of the findings. Of the 7,591 screened records, we included 57 articles. Most studies used a longitudinal design (n = 34/57), investigated resident-level (n = 29/57) and/or facility-level factors (n = 32/57), and fewer prescriber-level ones (n = 8/57). Studies included two types of outcome: overall volume of antibiotic prescriptions (n = 45/57), inappropriate antibiotic prescription (n = 10/57); two included both types. Resident-level factors associated with a higher volume of antibiotic prescriptions included comorbidities (5 out of 8 studies which investigated this factor found a statistically significant association), history of infection (n = 5/6), potential signs of infection (e.g., fever, n = 4/6), positive urine culture/dipstick results (n = 3/4), indwelling urinary catheter (n = 12/14), and resident/family request for antibiotics (n = 1/1). At the facility-level, the volume of antibiotic prescriptions was positively associated with staff turnover (n = 1/1) and prevalence of after-hours medical practitioner visits (n = 1/1), and negatively associated with LTCF hiring an on-site coordinating physician (n = 1/1). At the prescriber-level, higher antibiotic prescribing was associated with high prescription rate for antibiotics in the previous year (n = 1/1). Improving infection prevention and control, and diagnostic practices as part of antimicrobial stewardship programmes remain critical steps to reduce antibiotic prescribing in LTCFs. Once results confirmed by further studies, implementing institutional changes to limit staff turnover, ensure the presence of a professional accountable for the antimicrobial stewardship activities, and improve collaboration between LTCFs and external prescribers may contribute to reduce antibiotic prescribing.
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