Background

In hospitalized patients, the duration of antibiotic therapy for uncomplicated pneumonia is often longer than recommended in clinical guidelines. Consequences include increased risk of Clostridioides difficile infection and the emergence of antibiotic resistance. Reducing the duration of antibiotic therapy is an important goal of antibiotic stewardship (ABS) programs.

Objective

To evaluate the impact of a computerized physician order entry (CPOE)-based ABS intervention on treatment duration in respiratory infections and on antibiotic use.

Methods

A new type of prescription tool featuring a “soft stop order” was introduced into the CPOE system in the Respiratory Medicine department of a Thorax Center. The effect of this intervention was evaluated after 24 weeks using a retrospective before-and-after study design.

Results

A total of 210 patients were evaluated (preintervention group n=109, postintervention group n=101). Mean antibiotic treatment duration decreased from 9.59 days to 7.25 days (p<0.001). It was reduced from 9.93 to 7.21 days (p<0.001) in community-acquired pneumonia, 10.21 to 7.81 days (p=0.05) in hospital-acquired pneumonia and 7.81 to 6.83 days (p=0.14) in COPD exacerbations. The proportion of patients treated according to clinical guidelines increased from 35.8% to 69.3% (p<0.001). The mean quarterly antibiotic use density was 41.2 RDD/100 PD (recommended daily doses per 100 patient days) before the intervention and decreased to 34.03 RDD/100 PD after the intervention (p=0.037).

Conclusion

Our study demonstrates the short-term effectiveness of a CPOE-based ABS intervention to reduce antibiotic treatment duration for uncomplicated pneumonia. This approach may be particularly suitable for hospitals with limited ABS resources.

中文翻译：

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基于计算机化医嘱输入 (CPOE) 的抗生素管理干预对肺炎和 COPD 恶化治疗持续时间的影响

背景

在住院患者中，单纯性肺炎的抗生素治疗时间通常比临床指南中推荐的要长。后果包括艰难梭菌感染的风险增加和抗生素耐药性的出现。减少抗生素治疗的持续时间是抗生素管理 (ABS) 计划的一个重要目标。

客观的

评估基于计算机化医嘱输入 (CPOE) 的 ABS 干预对呼吸道感染治疗持续时间和抗生素使用的影响。

方法

一种具有“软停令”的新型处方工具被引入胸科中心呼吸内科的 CPOE 系统。在 24 周后使用回顾性的前后研究设计评估了这种干预的效果。

结果

共评估了 210 名患者（干预前组 n=109，干预后组 n=101）。平均抗生素治疗时间从 9.59 天减少到 7.25 天（p<0.001）。社区获得性肺炎从 9.93 天减少到 7.21 天（p<0.001），医院获得性肺炎从 10.21 天减少到 7.81 天（p=0.05），COPD 恶化从 7.81 天减少到 6.83 天（p=0.14）。根据临床指南接受治疗的患者比例从 35.8% 增加到 69.3% (p<0.001)。干预前平均季度抗生素使用密度为 41.2 RDD/100 PD（推荐的每日剂量/100 患者日），干预后降至 34.03 RDD/100 PD（p=0.037）。

结论

我们的研究证明了基于 CPOE 的 ABS 干预在减少单纯性肺炎的抗生素治疗时间方面的短期有效性。这种方法可能特别适用于 ABS 资源有限的医院。