德国维尔茨堡大学医院Alexandra Greser团队研究了初级保健中多模式干预减少女性尿路感染二线抗生素处方的效果。相关论文发表在2023年11月2日出版的《英国医学杂志》上。

为了评估全科医学中的多模式干预是否降低了女性无并发症尿路感染二线抗生素处方的比例和抗生素处方的总体比例，研究组在德国五个地区的全科机构进行了一项平行、整群随机、对照试验，参与者为来自128个随机分配诊所的全科医生。

多模式干预包括针对全科医生和患者的指南建议、提供抗生素耐药性的区域数据和季度反馈，其中包括抗生素处方的个人一线和二线比例、与区域或超区域全科医生的基准以及电话咨询。对照组的参与者未收到关于干预的信息。

主要结局为一年后在干预组和对照组之间，对于无并发症的尿路感染，全科医生开出的二线抗生素与开出的所有抗生素的比例。使用SAS 9.4版，将全科机构按区块（1:1）随机分配到干预组或对照组，区块大小为4；随机分组按区域分层。次要结局是相对于所有病例（尿路感染诊断病例），一年后两组之间治疗尿路感染的所有抗生素处方比例。不良事件作为探索性结果进行评估。

五个季度（即15个月）共确定了110个完整数据集的实践10323例。12个月后，干预组二线抗生素的平均处方比例为0.19（标准偏差0.20），对照组为0.35（0.25）。校正干预前比例后，平均差异为−0.13（P<0.001）。干预组和对照组治疗12个月以上尿路感染的所有抗生素处方的总比例分别为0.74（标准差0.22）和0.80（0.15），平均差异为-0.08（P＜0.029）。两组之间的并发症（即肾盂肾炎、入院或发烧）数量没有差异。

研究结果表明，全科医学中的多模式干预显著降低了女性无并发症尿路感染的二线抗生素和所有抗生素处方的比例。

附：英文原文

Title: Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial

Author: Guido Schmiemann, Alexandra Greser, Andy Maun, Jutta Bleidorn, Angela Schuster, Olga Miljukov, Viktoria Rücker, Anja Klingeberg, Anja Mentzel, Vitalii Minin, Tim Eckmanns, Christoph Heintze, Peter Heuschmann, Ildikó Gágyor

Issue&Volume: 2023/11/02

Abstract:

Objectives To evaluate whether a multimodal intervention in general practice reduces the proportion of second line antibiotic prescriptions and the overall proportion of antibiotic prescriptions for uncomplicated urinary tract infections in women.

Design Parallel, cluster randomised, controlled trial.

Setting General practices in five regions in Germany. Data were collected between 1 April 2021 and 31 March 2022.

Participants General practitioners from 128 randomly assigned practices.

Interventions Multimodal intervention consisting of guideline recommendations for general practitioners and patients, provision of regional data for antibiotic resistance, and quarterly feedback, which included individual first line and second line proportions of antibiotic prescribing, benchmarking with regional or supra-regional practices, and telephone counselling. Participants in the control group received no information on the intervention.

Main outcome measures Primary outcome was the proportion of second line antibiotics prescribed by general practices, in relation to all antibiotics prescribed, for uncomplicated urinary tract infections after one year between the intervention and control group. General practices were randomly assigned in blocks (1:1), with a block size of four, into the intervention or control group using SAS version 9.4; randomisation was stratified by region. The secondary outcome was the prescription proportion of all antibiotics, relative within all cases (instances of UTI diagnosis), for the treatment of urinary tract infections after one year between the groups. Adverse events were assessed as exploratory outcomes.

Results 110 practices with full datasets identified 10323 cases during five quarters (ie, 15 months). The mean proportion of second line antibiotics prescribed was 0.19 (standard deviation 0.20) in the intervention group and 0.35 (0.25) in the control group after 12 months. After adjustment for preintervention proportions, the mean difference was 0.13 (95% confidence interval 0.21 to 0.06, P<0.001). The overall proportion of all antibiotic prescriptions for urinary tract infections over 12 months was 0.74 (standard deviation 0.22) in the intervention and 0.80 (0.15) in the control group with a mean difference of 0.08 (95% confidence interval 0.15 to 0.02, P<0.029). No differences were noted in the number of complications (ie, pyelonephritis, admission to hospital, or fever) between the groups.

Conclusions The multimodal intervention in general practice significantly reduced the proportion of second line antibiotics and all antibiotic prescriptions for uncomplicated urinary tract infections in women.

DOI: 10.1136/bmj-2023-076305

Source: https://www.bmj.com/content/383/bmj-2023-076305