通过标准化诊断和治疗短肠综合征儿童小肠细菌过度生长的抗生素管理减少抗生素暴露并提高医疗保健成本。

IF 0.2 Q4 NURSING Journal of Doctoral Nursing Practice Pub Date : 2020-11-01 DOI:10.1891/JDNP-D-19-00080
Christie Heinzman, Conrad Cole
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引用次数: 2

摘要

背景:由于金标准检测的侵入性,小肠细菌过度生长(SBBO)在儿童短肠综合征患者中很难诊断。替代检测方法也有障碍,使提供者无法进行临床诊断。这导致了这一人群中抗生素的过度使用。提出了一种SBBO识别和规范化处理算法。目的:规范小儿短肠综合征SBBO的鉴别和治疗。方法:1年回顾性图表复习和文献复习。结果:146例住院患者的最终分析显示诊断和抗生素处方不一致。总共有28% (n = 41)的SBBO患者接受了抗生素治疗,包括继续使用家庭抗生素的患者(n = 27)、基于临床怀疑使用抗生素的患者(n = 12)和基于十二指肠抽吸使用抗生素的患者(n = 2)。10.2% (n = 15)的患者在没有明确临床指征的情况下使用抗生素,导致342天的抗生素暴露和24000美元的处方费用。结论:与SBBO相关的临床研究十分必要。同时,该算法指导提供者进行诊断和治疗决策。周到的抗生素处方是优化结果的关键,同时最大限度地减少抗生素的不良影响。对护理的启示:该算法使护理人员能够通过协作团队来最大限度地减少抗生素的过度使用。
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Antibiotic Stewardship Through Standardized Diagnosis and Treatment of Small Bowel Bacterial Overgrowth in Pediatric Patients With Short Bowel Syndrome Reduces Antibiotic Exposure and Improves Cost of Health Care.

Background: Small bowel bacterial overgrowth (SBBO) is difficult to diagnose in pediatric patients with short bowel syndrome due to the invasive nature of the gold standard testing. Alternative testing methods also have barriers leaving providers to diagnose clinically. This has led to antibiotic overprescribing in this population. An algorithm for SBBO identification and standardized treatment is proposed.

Objective: Standardize SBBO identification and treatment in pediatric short bowel syndrome.

Methods: 1-year retrospective chart review and literature review.

Results: Final analysis of 146 admissions revealed diagnostic and antibiotic prescribing inconsistencies. In total, 28% (n = 41) received antibiotics for SBBO including those who continued home antibiotic (n = 27), those prescribed an antibiotic based on clinical suspicion (n = 12), and those prescribed an antibiotic based on duodenal aspirate (n = 2). In 10.2% (n = 15) patients, antibiotics were prescribed without clear clinical indication resulting in 342 antibiotic exposed days and $24,000 in prescription costs.

Conclusion: Clinical research is greatly needed as it relates to SBBO. In the meantime, the proposed algorithm guides providers through diagnosis and treatment decision-making. Thoughtful antibiotic prescribing is key to optimizing outcomes while minimizing adverse effects of antibiotics.

Implications for nursing: The algorithm empowers nursing to minimize antibiotic overuse through collaborative teamwork.

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