医学
抗菌管理
药方
置信区间
泊松回归
心理干预
急诊医学
急诊科
观察研究
抗生素管理
抗菌剂
医疗急救
环境卫生
抗生素
内科学
抗生素耐药性
药理学
人口
化学
有机化学
精神科
微生物学
生物
作者
Shogo Otake,Yoshiki Kusama,Shinya Tsuzuki,Shota Myojin,Makoto Kimura,Naohiro Kamiyoshi,Toru Takumi,Akihito Ishida,Masashi Kasai
摘要
Abstract Background Antimicrobial prescription rates tend to be high in outpatient settings and Primary Emergency Medical Centers (PECs) in Japan encounter difficulties in implementing antimicrobial stewardship programs (ASPs). While a nudge‐based ASP publishing monthly newsletters reduces inappropriate prescription of oral third‐generation cephalosporins (3GCs), which requires considerable effort. Therefore, developing more preferable ASP models in PECs is essential. Methods We conducted a three‐center, retrospective observational study. Himeji City Emergency Medical Center (Site A) introduced a facility‐specific guideline for antimicrobial stewardship with reference to national guidelines. The Kobe Children's Primary Emergency Medical Center (Site B) provided the results of monitoring antibiotics prescription in a monthly newsletter. The Hanshin‐Kita Children's First‐Aid Center (Site C) did not perform a specific ASP. Prescription rates for 3GCs were categorized into pre‐ and post‐intervention and compared using Poisson regression analysis. The difference‐in‐difference method was used to assess the effect of these interventions. Results The numbers of patients pre‐ and post‐ intervention were 177,126 and 91,251, respectively. The 3GCs prescription rate at Site A, Site B, and Site C decreased from 6.7%, 4.2%, and 6.1% in 2016 to 2.3%, 1.0%, and 2.0% in 2019, respectively. Site B had a greater reduction than Site A and Site C (relative risk [RR] 0.71 [95% confidence interval (CI): 0.62–0.82]; p < 0.001, RR 0.71, [95% CI: 0.62–0.81]; p < 0.001). There was no significant difference between Site A and Site C (RR 1.00 [95% CI 0.88–1.13]; p = 0.963). Conclusion A facility‐specific guideline was less effective than a nudge‐based ASP for decreasing oral 3GC prescriptions in PECs.
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