急诊病房抗生素应用的临床审查（英文PPT）ClinicalAudit of the Use of Antibiotics in Acute Medical .pptVIP

Clinical Audit of the Use of Antibiotics in Acute Medical Wards Dr. Chan Kai Ming Microbiology / Infectious Disease Team Department of Pathology / Department of Medicine Geriatrics Tuen Mun Hospital Background Appropriateness in use of antibiotics directly affect the quality of care of patients. Patient care Morbidity Mortality Restriction in use Minimization of emergence of resistant strains Objectives Audit the use of antibiotics in the following aspects Initiation of the use of antibiotics Choice of initial subsequent antibiotics Duration of antibiotics Dose of antibiotics Route of administration Standards No international set criteria available for reference. Ideal situation 100% appropriateness in the antibiotic use for all patients Set standard 80% What is appropriate? Initiation of antibiotics Choice of antibiotics Duration/ dosage/ route of administration of antibiotics Criteria for appropriate initiation of antibiotics Empirical treatment/ clinical evidence/ suspicions on active infection Clinical sepsis Fever, raised white cell count Chills and rigors Signs and symptoms of active infection – consolidation of lung segment etc. Criteria for appropriate initiation of antibiotics Prophylactic therapy For example Prepare for procedures/ operation in underlying valvular heart disease Pre-emptive therapy For example Leukemic patient started on chemotherapy Anti-CMV treatment for transplant patient Criteria for appropriate choice of antibiotics Prescription of antibiotics in accordance to available guidelines Depends on diagnosis made Good guess of possible pathogen Change of antibiotics according to microbiological results Culture result Serological test etc. Criteria for appropriate choice of antibiotics Change of antibiotics according to clinical progress Suboptimal response to current antibiotics therapy Individual Allergy to antibiotics Criteria for appropriate duration/ dosage/ route of administration of antibiotics According to guidelines According to