Effects of a comprehensive antibiotic stewardship program on antibiotic prescribing for acute respiratory infections in rural facilities: a cluster randomized trial.

Here we conducted a pragmatic, cluster randomized controlled trialin 34 township hospitals in two rural counties of Guangdong, China, to evaluate whether a digitally enabled stewardship program could reduce antibiotic prescribing.

在这里，我们在广东省两个农村县的34个乡镇卫生院进行了一项实用的、群组随机对照试验，以评估一个数字化的药物管理计划是否能减少抗生素的处方。

The intervention combined training and guidelines for doctors; concise, evidence-based guidelines embedded in the electronic medical record with point-of-care prompts; monthly prescribing peer review feedback for doctors; and patient education delivered through a smartphone app.

干预措施结合了医生培训和指南；将简洁、基于证据的指南嵌入电子病历，并在临床护理时提供提示；为医生提供每月处方同行评审反馈；并通过智能手机应用程序向患者提供教育。

Control is usual care with no inputs.

对照组为常规护理，没有额外干预。

During the 12-month implementation period (1 March 2020 to 28 February 2021), we analyzed 97,239 eligible consultations for ARIs.

在12个月的实施期间（2020年3月1日至2021年2月28日），我们分析了97,239例符合资格的急性呼吸道感染（ARI）咨询。

The primary outcome was whether a consultation resulted in any antibiotics being prescribed.

主要结果是咨询是否导致开具了任何抗生素处方。

This outcome was met: antibiotics were prescribed in 26% (14,521/54,799) of intervention consultations compared to 71% (30,340/42,440) of control consultations, yielding an adjusted risk difference of -39 percentage points (95% confidence interval: -47 to -29; P < 0.001).

该结果得到满足：在干预咨询中，26%（14,521/54,799）的患者被开具了抗生素处方，而在对照咨询中，这一比例为71%（30,340/42,440），调整后的风险差异为-39个百分点（95%置信区间：-47至-29；P < 0.001）。

There was no evidence of increased harm, as 30-day hospitalization rates for respiratory illness or sepsis did not differ between groups (adjusted risk difference, 0.2 percentage points; 95% confidence interval: -0.3 to 0.6).

没有证据表明伤害增加，因为两组之间因呼吸道疾病或败血症导致的30天住院率没有差异（调整后的风险差异为0.2个百分点；95%置信区间：-0.3至0.6）。

A comprehensive stewardship program can substantially reduce inappropriate antibiotic prescribing for ARIs in rural primary care facilities in China without compromising patient safety.

全面的管理计划可以在不损害患者安全的情况下，显著减少中国农村初级保健机构对急性呼吸道感染(ARIs)的不适当抗生素处方。

Trial registration: ISRCTN96892547 .

试验注册：ISRCTN96892547。