现在的位置: 首页研究点评, 进展交流>正文
[NEJM作者回复]:降钙素原指导抗生素使用
2018年11月27日 研究点评, 进展交流 暂无评论

CORRESPONDENCE

Procalcitonin-Guided Antibiotic Use

N Engl J Med 2018; 379:1971-1973

DOI: 10.1056/NEJMc1811150

The authors reply: Pulia et al. correctly note that implementation of a procalcitonin guideline in our trial had minimal effect on antibiotic prescription in cases of community-acquired pneumonia, but in patients with acute bronchitis, antibiotic prescription in the ED dropped by 50%. However, the finding for acute bronchitis, while robust to correction for multiple comparisons, is a secondary outcome of a subgroup.

作者回复:Pulia等正确指出了,在我们的研究中,实时降钙素原指导对社区获得性肺炎患者的抗生素使用仅有很小的影响,但对于急性支气管炎患者,急诊科抗生素处方下降50%。然而,急性支气管炎患者得到的结果尽管经过多重比较的校正,却是本研究亚组分析的次要预后指标。

We agree with Bremmer et al. that combining two tools — a new diagnostic test and an antimicrobial stewardship program — could be effective and can be tested. We did not design that trial, seeking rather to assess the effect of a procalcitonin guideline alone, implemented in accordance with quality-improvement principles. ASPs require considerable resources.1

我们同意Bremmer等人的意见,即综合两种措施—新的诊断检查以及抗生素管理措施—效果更为明显。然而,我们并未进行此种试验设计,而是仅仅针对降钙素原指导本身(根据质量改进原则实时)的效果进行评估。ASP的实施需要相当多的资源支持。

Spellberg and Gaffin posit that in settings with higher baseline antibiotic use than observed in our trial, a procalcitonin guideline might have a different effect. The potential for variable effects applies to all interventions, with the extent of the effects varying in accordance with the surrounding environment. For example, the effects of educating clinicians on national antibiotic guidelines might differ depending on their current baseline use. We disagree with the suggestion that training in the use of procalcitonin was inadequate. As reported, we provided extensive education, real-time prompts, and feedback, modeling a best-case scenario for the deployment of a new intervention.

Spellberg和Gaffin提出假设,在基线抗生素使用超过我们研究水平的情况下,降钙素原指导可能具有不同的作用。这一考虑适用于所有干预措施,根据周围环境不同,干预措施的效果也会有所不同。例如,针对临床医生进行国家抗生素指南宣教的效果可能因基线使用情况而有所不同。我们不同意他们的观点,即降钙素原的相关培训不充分。正如我们报告指出,我们进行了广泛的宣教,实时提醒及反馈,这是实施新措施的最佳范例。

David T. Huang, M.D., M.P.H.
Donald M. Yealy, M.D.
Derek C. Angus, M.D., M.P.H.
University of Pittsburgh, Pittsburgh, PA

for the ProACT Investigators

给我留言

您必须 [ 登录 ] 才能发表留言!

×
腾讯微博