抗菌薬適正使用支援チームによる誤嚥性肺炎クリニカルパスの導入

抄録

Aspiration pneumonia (AP) accounts for approximately 80％ of pneumonia cases among the elderly, and its treatment can involve long-term administration of antibiotics and prolonged hospitalization. To optimize the treatment of AP, the antimicrobial stewardship team (AST) created and induced a clinical pathway (CP) for AP and evaluated its activities. First, we investigated the progress of patients treated for AP from January to September 2020. To address AP treatment issues, we identified three tasks: “antibiotics treatment,” “swallowing assessment,” and “early discharge support.” The AST developed and implemented the CP in November 2020. After the induction of the CP, the AST monitored the CP usage rate and appropriate use of antibiotics. Subsequently, clinical outcomes were compared in 142 patients before its induction from January to October 2020 and 115 patients afterwards from January to October 2021. After the induction of the CP, the median daily dose of sulbactam/ampicillin significantly increased from 6 to 9 g (P < 0.001). The water swallowing test evaluation significantly increased from 3.5％ to 38.3％ induction (P < 0.001). The median time to intervention for swallowing therapy was significantly shortened from 6 to 5 days (P = 0.023). The median administration duration of antibiotics was 8 days but significantly reduced to 7 days afterwards (P < 0.001). The median length of hospital stay significantly reduced from 20 to 19 days (P = 0.040). With the creation and induction of the CP for AP and post-induction monitoring, the periods of antibiotic treatment and hospitalization may be shortened.