The Use of Mobile Educational Tools to Improve Antimicrobial Prescription for the Treatment of Acute Pyelonephritis in Pregnancy: A Retrospective Cross-sectional Study

Abstract Objective To analyze the prescription of antimicrobial agents for pregnant women admitted into the obstetrics service who presented with acute pyelonephritis. Methods Three cross-sectional studies were performed comparing the prescription of antimicrobials for pyelonephritis in pregnant women in the time periods evaluated (2010-2011: 99 patients evaluated; 2013: 116 patients evaluated; 2015: 107 patients evaluated), at the Hospital Fêmina, Porto Alegre, in the state of Rio Grande do Sul, Brazil. The analysis was performed before and after the promotion of an institutional protocol for the treatment of pyelonephritis during pregnancy, and on a third occasion after the introduction of a smartphone-based mobile educational tool. Results The evaluation of the prescribing physicians and the adequacy of the prescriptions between the different periods studied revealed a significant increase in appropriate conduct for the choice of antimicrobial (2010: 83.8%; 2013: 95.7%; and 2015: 100%), route of administration (2010: 97%; 2013: 100%; and 2015: 100%), and interval (2010: 91.9%; 2013: 95.7%; and 2015: 100%), following the introduction of the protocol, and again after the implementation of the softwareapplicationwithorientationsontheantimicrobial treatment. Conclusion The use of specific mobile applications should be encouraged to attain a better quality and accuracy in prescriptions and to include strategies that not only reduce the risk of negative outcomes, but also improve the quality of care and treatment for maintaining the health both of the mother and of the baby.

【摘要】 目的：分析巴西南里奥格兰德州阿雷格里港费米纳医院产科收治的急性肾盂肾炎（acute pyelonephritis）孕妇的抗菌药物（antimicrobial agents）处方情况。
方法：本研究开展三项横断面研究（cross-sectional studies），对比该医院在三个评估时段（2010-2011年：纳入99例患者；2013年：纳入116例患者；2015年：纳入107例患者）中，妊娠期急性肾盂肾炎孕妇的抗菌药物处方方案。分析覆盖推广妊娠期肾盂肾炎治疗院内规程前后，以及引入基于智能手机的移动教育工具后的三个阶段。
结果：对不同研究时段的处方医师处置行为及处方合理性进行评估后发现，在推广院内规程后，以及搭载抗菌药物治疗指导的软件应用上线后，抗菌药物选择（2010年：83.8%；2013年：95.7%；2015年：100%）、给药途径（2010年：97%；2013年：100%；2015年：100%）及给药间隔（2010年：91.9%；2013年：95.7%；2015年：100%）的合理处置比例均显著提升。
结论：应鼓励使用针对性移动应用程序，以提升处方质量与准确性，制定相关策略不仅可降低不良结局风险，还能优化诊疗质量，维护母婴双方的健康。