Effects of refinement of clinical pathways on the rational use of antimicrobial drugs in hospitalized elderly patients with community-acquired pneumonia / 中华老年医学杂志

ABSTRACT

Objective:To explore the effects and value of implementing clinical pathway refinement on the rational use of antimicrobial drugs in elderly inpatients with community-acquired pneumonia(CAP)in secondary care hospitals.Methods:A total of 122 elderly patients with CAP admitted to the respiratory department of our hospital from April 1, 2018 to October 31, 2019 were enrolled as the subjects, and they were randomly divided into two groups the study group(n=61, receiving management of refined clinical pathways)and the control group(n=61, the selection of management types and duration determined by clinical experience). The rates of sample submission and positive sputum pathogens, the intensity of antibiotic use, course of treatment, drug costs, combined drug use, length of stay and costs of hospitalization were analyzed and compared between the two groups.Results:The sample submission rate and the positive rate of sputum pathogens were higher in the study group than in the control group(95.1% or 58/61 vs.73.8% or 45/61, 27.6% or 16/58 vs.13.3% or 6/45, χ2=10.536 and 5.545, P=0.001 and 0.019). There was no significance in the cumulative defined daily use(DDD), duration of all antibiotic administration and cumulative administration time between the study and control groups(41.8 or 46.5 vs.78.3 or 111.0, 41 d or 61 d vs.50 d or 131 d, 6 or 7 vs.9 or 15, Z=-0.526, -0.559 and-0.429, all P>0.05). The rate of combined antibiotic therapy was lower in the study group than in the control group(16.4% or 10/61 vs.65.5% or 40/61, χ2=30.500, P=0.000). The duration of antibiotic use, drug costs, length of stay and hospitalization expenses were lower in the study group than in the control group[(8.98±2.05)d vs.(11.75±3.16)d, (1 928.03±1 156.47)yuan vs.(2 335.92±1 038.56)yuan, (11.00±3.16)d vs.(13.90±3.72)d, (12 172.94±3 934.52)yuan vs.(14 036.85±5 591.11)yuan, t=5.748, 2.050, 4.643 and 2.129, P<0.05]. There was no significant difference in the cure rate and 30-day mortality between the study and control groups(95.1% or 58/61 vs.88.5% or 54/61, 4.9% or 3/61 vs.8.2% or 5/61, χ2=1.743 and 0.535, both P>0.05). Conclusions:The application of refinement of clinical pathways in elderly patients with CAP can effectively improve sample submission and detection rates of pathogenic bacteria in sputum, reduce the intensity of antibiotic use, duration, cost and rates of combined antibiotic therapy, decrease the in-hospital time and hospitalization expenses, and help promote rational use of antimicrobial drugs and control of medical expenses.